The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
February 12, 2003

 

 

 

Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

Personal Health for the Week of January 4-10

  1. Head-On Collusions


FRIDAY, JANUARY 10, 2003 

Pumped to Jump 

HealthScoutNews Reporter

Friday, January 10, 2002

(HealthScoutNews) -- Athletic shoes can make a real difference. The research comes from The University of Calgary in Alberta, Canada, as reported in Medical Science in Sports and Exercise.

Lots of energy in running and jumping is lost at the metatarsophalangeal joint, which is the point where the big toe meets the rest of the foot. So sneaker-makers thought if they made soles stiffer with carbon fiber plates, there wouldn't be the same energy loss, and people could run and jump better.

It turns out they were right. The carbon fiber plates really did reduce the amount of energy lost during jumping exercises. When 25 people tested the stiff soles, their jumps really did go higher -- by about half an inch.

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Hospital Implants Emotional-Stress Pacemaker

Reuters

Friday, January 10, 2002

CHICAGO (Reuters) - The first of a new kind of cardiac pacemaker, which responds to emotional stress, has been implanted in an 81-year-old female patient in Louisiana, doctors said on Friday.

The patient, whose name was withheld, was released from the Heart and Vascular Center in Lake Charles, Louisiana, on Thursday evening and is doing well, they said.

The Protos Pacemaker, manufactured by Biotronik of Germany, translates cardiac signals sent directly from the heart to determine the appropriate heartbeat rate.

Unlike traditional pacemakers, which use motion sensors and therefore respond only to heightened physical exertion, the Protos Pacemaker gets signals directly from the surface of the heart so it also responds when the heart beats faster due to emotional stress.

Cardiac electrophysiologist William Bailey, who implanted the pacemaker and who was a principal investigator in the US Food and Drug Administration (news - web sites) clinical trials, said this technology is the only pacemaker able to interpret what the autonomic nervous system is demanding.

"The difference is that there's feedback," Bailey said.

The Protos Pacemaker has a microprocessor, so new features can be installed by upgrading the software, he added.

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Long-Term Pill, Short-Term Memory

HealthScoutNews Reporter

Friday, January 10, 2002

(HealthScoutNews) -- Long-acting drugs that allow you to only take one pill a day have their drawbacks.

While you're more likely to remember to take your medication if it's once-a-day, according to Drugs & Aging, if you do forget, you've missed your treatment for the whole day.

By contrast, if you have a pill to take three or four times each day, you can forget one of them and still get most of the benefit.

In one study, subjects were just as likely to take once-a-day drugs and twice-a-day drugs. But the chance that they would go the whole day without any medication was twice as great with the once-a-day medicines.

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Vampire Bat Saliva Eyed for Stroke Drug

 

The Associated Press

Friday, January 10, 2002

DALLAS - A substance in the saliva of vampire bats could prove to be a potent new treatment for strokes, an Australian scientist says.

"When the vampire bat bites its victim, it secretes this powerful clot-dissolving substance so that the victim's blood will keep flowing, allowing the bat to feed," said Dr. Robert Medcalf of the Monash University Department of Medicine at Box Hill Hospital in Victoria, Australia.

That same substance — Desmodus rotundus salivary plasminogen activator, or DSPA — might someday be given to stroke victims to dissolve clots and thereby limit brain damage, he said.

The substance has yet to be tested for effectiveness and safety in humans, but it showed promise in preliminary experiments in mice. The findings were reported in Thursday's issue of the journal Stroke, published by the American Heart Association (news - web sites).

The research involves ischemic strokes, which are the most common kind of stroke and occur when a blood clot or narrowing of blood vessels prevents blood from getting to the brain. The other type of stroke is a hemorrhagic stroke, which occurs when a blood vessel bursts and causes bleeding in the brain.

Some ischemic stroke victims are given a clot-busting substance called tissue plasminogen activator, or TPA. But one major drawback of TPA is that it must be administered within three hours of the stroke's onset, or else the drug itself can cause bleeding and brain damage.

Medcalf's research team injected DSPA and TPA in mice and watched for brain damage. Mice that got DSPA suffered less brain damage.

Medcalf said that DSPA is not only a more potent clot-buster but can also be safely administered up to nine hours after the stroke's onset because it more precisely targets blood clots, which are held together by a string-like substance called fibrin.

"DSPA is almost inactive in the absence of fibrin and therefore much more fibrin-specific than TPA," Medcalf said.

One expert warned that the research was limited to mice that had not suffered strokes.

"This is several factors removed from a necessarily meaningful clinical effect," said Dr. Larry Goldstein, director of Duke University's Center for Cerebrovascular Disease and chairman of the American Stroke Association Advisory Committee. "Does this have potential? Yes. But whether it will prove to be safe or efficacious for humans with strokes, that's a whole different story."

And Dr. Keith A. Siller, an assistant professor of neurology at the NYU School of Medicine, said that the nine-hour window is not necessarily an advantage. He said that any drug administered after three hours is essentially pointless because the damage to the brain has already been done.

On the Web:

American Stroke Association: http://www.StrokeAssociation.org

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Surgery May Help Kids with Leg, Hip Tumors

Reuters Health

Friday, January 10, 2002

NEW YORK (Reuters Health) - A group of Italian orthopedic surgeons may have hit upon a new bone reconstruction technique that can help young children with bone cancer in the lower limbs.

Treating tumors in children's leg and hip bones has been difficult because conventional methods of lower limb bone repair do not allow for growing bones, according to a statement from the January 11th issue of the journal The Lancet, where the study is published. Children may need multiple surgeries, or doctors may decide to amputate the affected limb.

In the new study, Dr. Marco Manfrini and colleagues at the Istituto Ortopedico Rizzoli in Bologna report on their treatment of a 4-year-old girl with a tumor in her hip and femur, or thigh bone.

After the girl underwent anti-cancer treatments including chemotherapy, Manfrini and colleagues started reconstructive surgery.

Using titanium screws and plates as well as bone grafts from the girl's leg bones, the team of surgeons reconstructed her hip. They also removed a portion of the girl's fibula, the smaller of the two bones joining the knee and the ankle, and used it along with another bone graft to replace part of her femur.

After four months the girl started strengthening exercises and after eight months she was able to bear some weight on the leg while using protective devices.

Four years and five months after the surgery, "the patient attends school, rides an exercise bicycle, swims, and walks without canes at home," the authors write.

The grafted bone has grown sufficiently so that her legs are the same length, and areas where bone grafts were taken have healed.

"This case suggests a new method of hip reconstruction in a small child," write Manfrini and colleagues.

"If long-term follow-up substantiates this promising early result, such reconstruction might become a viable option to amputation in this age group," the authors conclude.

Source: The Lancet 2003;361;141-143.

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Agriculture Sec. Defends School Lunch Plan

By Emily Gersema

Associated Press Writer

The Associated Press

Friday, January 10, 2002

WASHINGTON - School lunches relying on federal guidance and food aren't making American kids fatter, as critics contend, Agriculture Secretary Ann Veneman insisted Friday.

The nutritional value of food in school cafeterias is expected to be the focus of debate in Congress in the coming months as lawmakers look at renewing school lunch and other child nutrition programs overseen by the Agriculture Department.

"We cannot blame obesity on child nutrition programs in this country," Veneman said in an interview with The Associated Press.

Veneman's department is responsible for distributing food such as surplus meat, vegetables and fruit to schools to feed needy children. The agency also provides food for breakfast programs at some schools and gives them nutritional guidance.

The Physicians Committee for Responsible Medicine argues that school lunch is partly to blame for young people being overweight.

But Veneman emphasizes that the government is not the primary food provider for children.

"The bulk of the eating decisions, or the buying, is done by the parents," Veneman said.

The surgeon general warned in 2001 that obesity is an escalating epidemic that affects 13 percent of children and 60 percent of adults. The announcement left many people wondering who is responsible, which foods are causing obesity, and what can be done to trim waistlines.

Jen Keller, a dietitian for the physicians' group, said school lunches offer poor choices that can lead to bad eating habits.

At schools, "you see chicken nuggets, you see pork chops, sausage pizza, pepperoni pizza," Keller said. "I think we all know that those foods aren't really healthy ones."

Keller said much of the food that USDA offers schools is provided through surplus purchases, which the government uses to help farmers facing low prices.

Livestock groups take offense at being blamed for chubby schoolchildren.

"Where's the statistics, the backup that shows this is causing obesity?" said Kara Flynn, spokeswoman for the National Pork Producers Council. "It's an anti-meat attack as usual. Meat is a healthy product. Protein is something we've all read reports about, that you need."

The Food Research and Action Center, a group advocating to enroll more children in the school lunch program, said the physicians' claims "are absurd."

"School lunches meet about a third of kids' nutrient needs, and they have very definite portion sizes, and none of the portion sizes are what I would call 'super-size,'" said Lynn Parker, director of the center's child nutrition programs.

School lunches are designed to meet USDA dietary guidelines for meat, grains, dairy, fruits and vegetables. Parker said: "We're not seeing high-calorie sodas as part of lunch. We're not seeing dessert items as a large part of lunch."

Consumer groups blame fast-food restaurants, food companies and the government for America's obesity problem. And food companies blame individuals, arguing that they need to learn when to stop eating and to exercise. While people should take some responsibility for obesity, the problem also is caused by their environment, Parker said.

"It's asking a lot of a human being to face all of the temptations and all of the limitations on activity," she said.

On the Net:

Agriculture Department: http://www.usda.gov

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Report Highlights Potential Dangers of Supplements

By Amy Norton

Reuters Health

Friday, January 10, 2002

NEW YORK (Reuters Health) - Better safety monitoring is needed for dietary supplements, some of which have the potential for "substantial hazard," according to a US study released Thursday.

The study of 11 poison control centers nationwide found that the centers received more than 2,300 calls about dietary supplements in 1998. In all, researchers believe nearly 500 people had symptoms likely caused by a supplement, and the "adverse events" ranged from mild to serious.

In fact, one third of supplement-related problems were moderate or severe, according to findings published in the January 11th issue of The Lancet.

Serious symptoms included seizure, heart-rhythm disturbances and liver dysfunction, among other problems. Four deaths were thought to be tied to supplements.

These poison-control figures cannot be used to estimate the safety risk to the average consumer taking dietary supplements, since many variables go into that, the study authors point out.

Still, they say the findings highlight the fact that supplements, despite their widespread "natural" image, can carry side effects.

"The most important implication for the general public is that serious adverse events do occur (with) over-the-counter dietary supplements," Dr. Susan Smolinske, one of the study authors, told Reuters Health.

The side effects, if any, naturally vary with the supplement, added Smolinske, of Wayne State University in Detroit, Michigan.

In this study, she said, some of the supplements "more likely to be a problem" included ma huang, guarana, ginseng and St. John's wort, as well as products containing multiple active ingredients.

Ma huang, also known as ephedra, is an ingredient of some supplements touted for weight loss. The herb affects the cardiovascular and central nervous systems, and has already been linked to the risk of seizure, heart attack and sudden death, even in healthy people. The US Food and Drug Administration (news - web sites) has issued an alert warning consumers against its use, particularly along with caffeine.

Guarana is another herbal stimulant used in some products sold as energy boosters and diet aids (news - web sites). Potential side effects include nausea, anxiety and irregular heartbeat.

Both ginseng and St. John's wort can interact with certain prescription drugs. And heavy overdoses of ginseng have been reported to cause sleeplessness, muscle tension and swelling.

Dietary supplement refers to a broad category of products that includes herbs, vitamins, minerals, amino acids and various traditional "remedies." Unlike drugs, these products are not evaluated by the US Food and Drug Administration for safety and effectiveness before hitting the market.

According to Smolinske and her colleagues, their findings suggest that dietary supplements require better surveillance--"particularly mandatory reporting of adverse events."

In addition, they call for a comprehensive registry of dietary supplements so that information on their intended effects and side effects is easily accessible to poison control centers and others. Only about a third of the supplements reported to the centers were listed on the main commercial database that poison-control staff use.

The findings also "warrant concern" about the lack of child-resistant packaging on supplements, the study authors add. Among the reports of adverse symptoms were 48 cases involving children who accidentally took a supplement.

Source: The Lancet 2003;361:101-106.

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Nicotine Replacement Backed Despite Cancer Study

By Randy Dotinga
HealthScoutNews Reporter

Friday, January 10, 2002

 FRIDAY, Jan. 10 (HealthScoutNews) -- Nicotine replacement products are much safer than smoking despite a new study suggesting that nicotine could play a role in lung cancer.

That assurance comes from a leading maker of these products as well as researchers who reported last week that nicotine appears to give a helping hand to cancer cells in the lungs.

"Our study is probably the first to show that nicotine can act similarly to a carcinogen," says Kip A. West, a researcher with the National Cancer Institute (news - web sites).

However, the study is based on findings in the laboratory, and researchers haven't tested their theories on animals or humans. And the scientists aren't suggesting that smokers give up trying to quit with the aid of nicotine replacement products, which now include lozenges in addition to the ubiquitous patches and gum.

To make the point even clearer, GlaxoSmithKline issued a statement saying the risks of using nicotine-based smoking cessation products "are extremely small compared to the known deadly risks of smoking." The pharmaceutical company makes NicoDerm CQ nicotine patches, Nicorette gum and Commit lozenges, which let smokers slowly wean themselves off their addiction by getting doses of nicotine without having to light up.

According to the American Cancer Society (news - web sites), the nicotine replacement products deliver lower doses of the chemical than tobacco. They also let smokers focus more on the psychological difficulties of quitting than the physical addiction.

While nicotine is considered to be largely responsible for turning smokers into addicts, scientists have not considered it to be a cause of cancer. Instead, researchers blame hundreds of other poisonous chemicals in cigarettes, pipes and cigars.

Federal researchers, however, wondered whether nicotine could play a role in the development of cancer. They set up experiments involving lung cells in a laboratory and report their findings in a recent issue of the Journal of Clinical Investigation.

In a healthy body, cancer-infected cells will automatically activate a kind of suicide program: The cells will kill themselves before they can wreak havoc on the body. However, when researchers hit human lung cells with cancer-causing chemicals, the levels of nicotine normally experienced by smokers appeared to prevent the cells from switching on the suicide protocol.

"It has a protective effect," West says. The survival of the cells, in turn, "allows them to accumulate mutations that would enable them to become tumor cells."

The researchers found that nicotine and a related chemical in tobacco known as NNK appear to affect the cells by influencing pathways where command signals travel.

What does this mean for nicotine products that are geared to help people stop smoking? West says the research does raise concerns if people use the products for a long time. "Prolonged use could be a bad thing," he says.

GlaxoSmithKline says its products are designed to be used over 10 to 12 weeks as a "step-down therapy" that more than doubles the chances of successfully quitting over the "cold turkey" approach.

However, the company suggested that long-term use might not be a problem. It cited a 1997 federally funded study that found people could safely take nicotine gum for five years.

What To Do

For a fact sheet on nicotine replacement products, go to the American Lung Association or the American Cancer Society.

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Breast Cancer Risk Type Not Equal in Both Breasts

By Alison McCook

Reuters Health

Friday, January 10, 2002

NEW YORK (Reuters Health) - Women diagnosed with a condition linked to an increased risk of breast cancer (news - web sites) appear to be more likely to develop cancer in one breast rather than the other, according to new research.

This discovery may encourage women to opt for less drastic measures when it comes to cutting their risk of breast cancer, the authors note.

Women with a benign condition known as atypical lobular hyperplasia have been shown to have a risk of breast cancer that is approximately 20% higher than that seen in the general population. Previously, doctors believed that the risk of breast cancer was equal in both breasts, regardless of where the atypical hyperplasia was discovered.

This belief, in some cases, would lead women with the benign condition to opt for removing both breasts to eliminate their risk of future disease, a procedure known as bilateral mastectomy.

Now, a second look at 252 women diagnosed with atypical lobular hyperplasia between 1950 and 1985 who did not receive any treatment for the condition shows that of those who developed breast cancer, almost 70% of cases occurred in the breast where the hyperplasia was found.

The disease appeared in the opposite breast in only 24% of breast cancer cases, report Dr. David L. Page and his colleagues at Vanderbilt University Medical Center in Nashville, Tennessee.

"People have believed for decades that the disease (risk) was equal in both breasts. And obviously, that is not the case," Page told Reuters Health.

Total mastectomies are also likely not necessary for all women with this benign breast condition, Page added. The current study findings suggests that patients can now opt for a much simpler course of action.

"We are suggesting that we can develop an alternative, which is removal of part of the tissue in just one breast," he said.

Page and his colleagues report their findings in the January 11 issue of The Lancet.

A total of 50, or one fifth, of the women first diagnosed with atypical hyperplasia eventually developed breast cancer.

Page explained that atypical hyperplasia is deformity of a special type of cell that is growing in a certain pattern within the breast lobules, a cluster of glands that produce milk while a woman is lactating.

Many women diagnosed with the benign condition do not choose mastectomy, Page noted. Some may opt only for careful follow-up, while others decide to take tamoxifen to cut their cancer risk, a drug that can prevent breast cancer.

Page added that he hopes these findings encourage doctors to rethink drastic measures when faced with a patient at risk of a condition, when less drastic alternatives exist.

Many women with atypical hyperplasia likely do not need mastectomies because most of the breast tissue is fat, Page explained. Rather, he suggested that doctors treating these women remove only part of the breast tissue, and leave the fat behind, a procedure that resembles breast reduction surgery.

Source: The Lancet 2003;361:125-129.

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Chemo Treatment Shows Promise Against Lupus

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews Reporter

Friday, January 10, 2002

FRIDAY, Jan. 10 (HealthScoutNews) -- A new way to use a standard chemotherapy drug holds promise for re-booting the immune system of those afflicted with lupus -- a disease in which the body turns on itself.

That's the word from doctors at Johns Hopkins Medical Center, who reported their successful treatment approach in today's issue of Arthritis and Rheumatism.

According to researcher Dr. Michelle Petri, the treatment involves blasting the body with extremely high doses of the chemotherapy drug cyclophosphamide.

"The idea here is to essentially wipe out the immune system and allow the body to reprogram itself to function normally," Petri says.

In healthy people, the immune system's killer cells are called into play only when a harmful bacteria or other cell-destroying factor invades the body.

In lupus patients, however, the immune system goes awry, viewing healthy cells as targets for destruction.

Doctors estimate that 500,000 to 1.5 million Americans are afflicted with lupus, mostly women, with a high percentage in the black community.

"Despite treatment, in about half of all our lupus patients this disease has claimed one or more organ systems," Petri says.

In the past, cyclophosphamide has been used in small doses over a long period of time in hopes of slowly wiping out the renegade immune cells. While the treatment was somewhat successful, the effects were not long-lasting.

Other attempts at using high doses of cyclophosphamide have produced less favorable results. Petri suspects that's because those trials involved removing some of the patient's bone marrow before treatment, and then replacing it afterward -- ostensibly to help the body rejuvenate after the drug therapy.

"But we believe this simply reintroduced the bad immune cells back into the body," Petri says.

In the new research, Petri and her colleagues found that because cyclophosphamide does not affect stem cells, which help build new bone marrow, there is no need for bone marrow removal or replacement. This, she says, may be the secret to the treatment's success.

"The immune cells are destroyed but the stem cells remain and they go to work rebuilding a new and hopefully normal immune system beginning right after treatment," Petri says.

Dr. Robert Lahita, chief of rheumatology at St. Vincent's Medical Center in New York City and chairman of the World Congress on Lupus 2004, says Petri's approach is a bit of a throwback to less sophisticated times. Ironically, it could also be a step toward a lupus cure, he adds.

"This idea of blasting cells with chemotherapy drugs is still an old-fashioned way of treating disease, but it's the best thing we have until we discover a major cure," Lahita says.

Even more important, he says, is that "it holds the potential for many different diseases. The idea of re-booting the immune system holds much promise in many different areas of treatment, which is what makes this study particularly important and relevant."

The new research involved just 14 lupus patients, all with advanced disease that had not responded to previous treatment. Each patient received four days of high-dose cyclophosphamide treatment, followed by close medical supervision for several weeks.

According to Petri, some of the patients developed fevers and infection following treatment -- ostensibly because their immune system was virtually not functioning -- and they required hospitalization for antibiotic treatment.

However, after following the patients for up to 43 months, the researchers found five of the 14 had a complete response, with no signs of lupus activity in their body. Six other patients had a partial response and were able to control their disease with the use of several medications that had previously failed to work. The treatment was considered to have failed in just three of the 14 patients.

"They may have had some pockets of cells hiding that the medication simply could not reach, or their body may simply be programmed to have lupus no matter what," Petri says.

While the treatment holds much promise, Lahita cautions that "it should only be performed by extremely experienced rheumatologists under strict laboratory conditions to ensure patient safety."

Further research on this treatment will be conducted at three medical centers beginning almost immediately: Hanneman Hospital in Philadelphia, the University of Wisconsin School of Medicine, and again at Johns Hopkins School of Medicine.

Patients with advanced lupus who have not previously been treated with cyclophosphamide may be eligible. For more information, call the Lupus Center at 410-614-1573 or contact stdman@jhmi.edu

More information

To read more about lupus, visit The Lupus Foundation. For more clinical trials involving this and other treatments for lupus, visit the National Institutes of Health.

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Most Women Continue Hormone Replacement –Report

Reuters

Friday, January 10, 2002

WASHINGTON (Reuters) - More than half of women taking hormone replacement therapy stuck with it last year despite reports that show it can raise the risk of heart disease, cancer and stroke when taken in the long term, a report issued on Thursday found.

In the four months after last July's surprise announcement, 36% of women stopped using HRT, according to the study by pharmacy benefit manager Express Scripts.

But 57% continued using them, the St. Louis-based company found.

And even though the studies found no extra risk for women taking estrogen alone, 22.6% of those surveyed stopped taking an estrogen product, Express Scripts said.

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New Hope for Kids With Bone Cancer

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews Reporter

Friday, January 10, 2002

FRIDAY, JAN. 10 (HealthScoutNews) -- Italian surgeons who reconstructed a young cancer patient's hip by using a combination of the patient's thighbone and a donor bone graft report the new joint is still doing well more than four years later.

Writing in a research letter in tomorrow's issue of The Lancet, Dr. Marco Manfrini from the Rizzoli Orthopaedic Institute in Bologna and his colleagues describe the procedure that was done.

The girl was 4 years old when she came to their attention in mid-1997 with a diagnosis of Ewing's sarcoma, a bone tumor. The cancer extended from the upper part of her femur, or thighbone, which makes up the "ball" part of the hip's "ball and socket" anatomy, to the middle of her thighbone. Today, the girl has full hip mobility and can attend school, ride an exercise bike, swim and walk without canes at home. She also has no discrepancies in limb lengths.

While surgeons have previously reconstructed other skeletal segments lost to cancer, the Italian authors note that "no limb-salvage techniques have been described for hip reconstruction in this age group."

Ewing's tumor, also called Ewing's sarcoma, most often occurs in children and adolescents between the ages of 10 and 20. Bone tumors, the growth of abnormal cells in the bones, can be cancerous or not; Ewing's is cancerous. It most often develops in the arms or legs but can occur in any bone. Symptoms include pain and swelling. Treatment typically involves a combination of surgery, radiation and chemotherapy, with amputation or reconstruction also done. About 60 percent are cured.

Manfrini and his team first removed some of the girl's cancerous thighbone and then transplanted her calf bone, keeping the blood supply intact, to create a new thigh bone. This transplant was inserted into a large piece of donor thighbone that was cut and shaped to fit. The new construction was held in place with small screws and a long titanium plate.

Main muscles were all reattached to the newly fashioned joint.

After four months, the girl exercised on a stationary bike, and by nine months she had active movement of the hip. At the time of the report, four years and five months after the reconstruction, the girl is disease-free, the authors note.

The graft grew lengthwise and cross-sectionally. The head of the thighbone also grew.

The researchers did a medical literature search and did not find any reports of the type of reconstruction they did in large joints of the lower limb.

The report is called "fascinating" by a medical oncologist familiar with the problem of Ewing's sarcoma.

"It's a remarkable kind of treatment," says Dr. Herman Kattlove, a medical oncologist and medical editor for the American Cancer Society (news - web sites). "What they did is almost miraculous. They had to keep the blood supply intact. The surgeons must be very skilled."

However, he adds a caveat: "We need to wait and see how it all turns out. I suspect she will need a hip replacement when she becomes full size. But still, she has a functioning leg for now and that is a plus." And hip replacement surgery, these days, is routinely done, he says.

More information

For more information on bone tumors, see Merck ManualHome Edition or the American Cancer Society.

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Study Suggests Way to Boost Blood-Platelet Supply

Reuters Health

Friday, January 10, 2002

NEW YORK (Reuters Health) - New research hints at a possible way to extend the shelf-life of platelets, tiny blood cells that are used in millions of transfusions each year, yet often go to waste because they cannot be refrigerated.

Scientists have long puzzled over why chilling renders platelets useless for transfusion--a fact that makes the cells different from other blood products, and all transplantable tissue.

Now researchers at Harvard University and Brigham and Women's Hospital in Boston, Massachusetts believe they have discovered why: Chilling platelets causes a change on the blood cells' surface that ultimately makes them targets for removal after they are transfused into the recipient.

The scientists speculate that making specific changes to the platelets could permit the cells to be chilled, yet still function normally after transfusion.

Dr. Karin M. Hoffmeister and her colleagues report their findings in the January 10th issue of the journal Cell.

Platelets are necessary for normal blood clotting and protect against blood loss by clumping together at the site of a vessel injury. Platelet deficiency due to bone marrow failure can lead to life-threatening bleeding, and less severe deficiencies can spur bleeding after surgery or injury. Platelet transfusion--performed more than 4 million times in the US each year--can counter these problems.

However, Hoffmeister's team point out, it's estimated that up to half of the US platelet supply goes to waste because of its short, 5-day shelf-life at room temperature.

Platelets are able to stick to blood vessel damage spots, in part, because they have receptors on their surface that bind to von Willebrand factor (vWf), a protein that also arrives at the site of vessel injury.

In the new study, the researchers found that chilling causes these vWf receptors to form clusters on the platelets' surface. This, in turn, causes a receptor on white blood cells in the liver called CR3 to target and remove the platelets from the blood circulation.

However, in mice that lacked the CR3 receptor, chilled platelets did not disappear from circulation and were able to function normally.

All of this suggests that altering the vWf receptors on platelets could allow the cells to be refrigerated without harming their usefulness for transfusion, according to the researchers.

In a statement, study co-author Dr. Thomas P. Stossel said: "Refrigeration of platelets could significantly impact platelet transfusion technology by increasing available platelet supplies."

Source: Cell 2003;112:87-97.

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Straight Talk About Herbal Supplements

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews Reporter

Friday, January 10, 2002

FRIDAY, Jan. 10 (HealthScoutNews) -- If you have high blood pressure, did you know you probably shouldn't take ginseng?

Or that St. John's wort can interfere with chemotherapy?

Or that garlic capsules and gingko biloba can hinder blood coagulation, a potentially major problem if you had to undergo surgery?

A new Web site created by experts at Memorial Sloan-Kettering Cancer Center in New York City provides up-to-date information on the safety and efficacy of 135 of the most popular herbal remedies and dietary supplements, from bee pollen to shark cartilage and skullcap to milk thistle.

Each entry includes a summary and a critique of all the known medical studies on the supplement, as well as a link to the original research on the National Institutes of Health (news - web sites)'s Medline.

In the past decade, use of alternative treatments has skyrocketed, says Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering, who started the site. "But until now there was no easy access to current, comprehensive information about these agents," she adds.

Research is under way around the globe to scientifically document the effects of hundreds of herbs and other dietary supplements.

Some studies have proven that certain herbs do have benefits, though in nearly all cases research is mixed. Zinc, for example, has shown promise in lessening the duration of a cold by making it difficult for the rhinovirus to replicate. And some research shows St. Johns wort can help ease depression.

But that means the converse is also true -- herbs can be dangerous.

"Herbs are powerful, biologically active products that do have important biological effects," Cassileth says. "Those effects can be useful at some times and harmful under other circumstances."

"Herbs should not be used in a casual fashion because they are serious medicines," she adds.

For instance, ginseng can cause low blood sugar in diabetics (news - web sites). And valerian and kava can lessen the effectiveness of prescription drugs by interfering with the liver's ability to process the medicines, Cassileth says.

Another thing to keep in mind: While much is known about the effects of herbs on the body, much more is not known.

Dietary supplements are not regulated by the U.S. Food and Drug Administration (news - web sites), or any government agency. That means the potency in one bottle of St. Johns wort, for example, can -- and often does -- vary dramatically from that in another bottle, Cassileth says.

And you can't even be sure you're getting St. Johns Wort.

"Anybody can put anything on a bottle and put it on a health food store shelf," she says. "Some of the herbal remedies have virtually none of what is assumed to be the active ingredient, some have much higher levels and some are contaminated with other substances."

On the new Web site, the 135 supplements are listed in alphabetical order by scientific name. The common name is below it. (Acanthopanax Senticosus is better known as ginseng. Allium Sativun is better known as garlic).

Each entry includes the brand names the herb is sold under, its purported uses, its chemical properties, and what's known about how the herb works on the body.

Each entry also includes a summary and a critique of all the known published medical studies, instances of adverse reactions, and warnings about potentially dangerous drug interactions.

Each critique is fully cited and linked to Medline, so that doctors or patients can retrieve the original research and read further if they wish.

The site will be continually updated, Cassileth says. In a few weeks, Cassileth and her colleagues are planning to launch a second Web site that will be less technical and more easily understood by patients.

Dr. David Rosenthal, past president of the American Cancer Society (news - web sites), endorses the Web site.

"This resource is an invaluable tool for both doctors and patients looking for comprehensive information about dietary supplements," Rosenthal says.

More information

To visit the Sloan-Kettering site, click here. For more on herbal medicine, visit the National Institutes of Health.

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Death from Accidents, Homicide Highest Among Poor

Reuters Health

Friday, January 10, 2002

NEW YORK (Reuters Health) - Being of lower socioeconomic status--based on occupation, income and education--increases the risk of dying from car accidents, fires, poisonings, falls and homicides, especially for men, new study findings show.

Researchers found that men who fell into the lowest 25% in terms of socioeconomic status were nearly three times more likely to die of such causes than men in the highest 25% of people in terms of socioeconomic status.

A similar trend was also seen for women but to a lesser extent, according to the report in the January issue of the journal Epidemiology.

Deaths from such causes are the second leading killer of people younger than 75, and "merit special attention because most are potentially preventable," note Dr. Kyle Steenland of Emory University in Atlanta, Georgia and colleagues.

There is little available information on the relationship between death from such causes and socioeconomic class, the authors add.

To investigate, Steenland's team evaluated death certificates for 261,723 adult men and women who died from accidents, homicides or other external causes between 1984 and 1997. Information on a person's occupation was included on his or her death certificate.

Women in the lowest socioeconomic class were 1.6 times more likely to die from an external cause than women in the highest socioeconomic class, but death risk for women in the middle was basically the same as it was for the highest-status women.

"In summary we have found that all major categories of death from external causes among ages 20-64 are related to socioeconomic status for both men and women," the authors write.

The investigators also found that blacks had a 74% increased risk of death from external causes compared to whites, even after accounting for the effects of socioeconomic status.

"We estimate that approximately 41% of such deaths are preventable if those in the lowest three quartiles of socioeconomic status had the same income and education as those in the top quartile of socioeconomic status," the researchers conclude.

Source: Epidemiology 2003;14:74-79.

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What's Behind Teen Obesity?

HealthScoutNews Reporter

Friday, January 10, 2002

FRIDAY, Jan. 10 (HealthScoutNews) -- Income and education levels aren't always the most important factors influencing adolescent obesity, says a study in the January issue of Obesity Research.

The University of North Carolina at Chapel Hill study says gender and ethnic-racial factors also play an important role.

The study found that weight problems were lower among white girls from high-income, better-educated families than among other white girls. However, the study found that wasn't the case when they looked at black girls from high-income, well-educated families.

The researchers wanted to find out why obesity is higher in minority groups. They analyzed data collected from 13,113 American adolescents enrolled in the National Longitudinal Study of Adolescent Health.

Using statistical techniques, they examined the relationship of family income and parents' education to the rates of weight problems in different racial and ethnic groups. The researchers also wanted to find out what happened when they mathematically equalized income and education among all the adolescents in the study.

When they did that and made everyone have an income of $80,000 or more, they found that rates of obesity were low for white, Hispanic and Asian girls, but high for black girls. The difference between white and black girls was actually highest at the highest income and education levels.

The study found a less extreme pattern among adolescent males, where there was higher rates of obesity among Hispanic and black males compared to Asian and white males.

The researchers conclude that obesity is not just a reflection of socioeconomic differences, as commonly believed. They suggest environmental, cultural, contextual and community factors also need to be addressed to find solutions for teen obesity in the United States.

For example, changing environmental factors could include increasing recreational opportunities or creating communities that encourage walking.

More information

Here's where you can learn more about childhood obesity.

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Dutch Study to Look at Injected Smoking Vaccine

By Andrew Conaway

Reuters Health

Friday, January 10, 2002

AMSTERDAM (Reuters Health) - The University of Maastricht announced Friday that it will begin a two-year study of Nabi Biopharmaceutical's anti-smoking vaccine, NicVAX, in the Netherlands.

The vaccine, which is injected, is derived from nicotine itself. Initial clinical trials of the product began in 2002.

The Phase I study, to be done at the university's ExTra Research Institute in partnership with the US-based biopharmaceutical company, will involve 21 Dutch smokers and nine non-smokers. Phase I trials are the most preliminary of studies in humans, and are designed to determine if a drug is safe for use in people. Later and larger studies are used to determine if a product actually works as intended.

Initial trials of the vaccine have been conducted in non-smokers in the US.

It is hoped that NicVAX will stimulate the immune system to produce antibodies that will bind to nicotine and stop it from crossing the blood/brain barrier. Once nicotine crosses the barrier into the brain, it stimulates the production of certain neurotransmitters, such as dopamine, which in turn generate positive sensations for the user.

"In terms of time to market, we are talking years," Nabi's Chairman and CEO David Gury said in an interview with Reuters Heath, "However, we feel that this product has potential for tremendous public, as well as humanitarian impact, on a product that microgram for microgram is very much more addictive than cocaine."

This is not the first anti-smoking vaccine to be developed. Last year British biotechnology firm Xenova successfully completed early trials of its TA-NIC vaccine, but that is also not expected to come to market for another several years.

According to the World Health Organization (news - web sites), the Netherlands has one of the highest percentage rates of smoking in the EU, with more than 30% of the country's population engaged in the habit.

The researcher leading the study, Professor Dr. O. Van Schayk, was traveling and unavailable for comment.

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Interleukin's Good Side

HealthScoutNews Reporter

Friday, January 10, 2002

FRIDAY, Jan. 10 (HealthScoutNews) -- Mayo Clinic researchers have found the hormone interleukin-6 protects brain cells in mice, a finding that may hold promise for humans as well.

The good news comes from a study in the Jan. 15 issue of the Journal of Neuroscience.

Interleukin-6 (IL-6) is found inside cells. The hormone is often regarded as a negative player in the immune system because of its association with inflammation injuries and malignant diseases. However, this study says Il-6 protects brain cells in mice.

The researchers studied different groups of mice that were genetically engineered to have variations in their ability to produce IL-6. All the groups of mice were injected with a virus that causes a degenerative nerve disease.

Of the 23 infected mice with the IL-6 gene, two died. In the infected mice that lacked the IL-6 gene, 17 of 29 died.

When they examined the mice, the Mayo Clinic scientists found dramatic degeneration of neurons in the spinal cords of the mice without the IL-6 gene. When they examined the brains of the mice with the IL-6 gene, they found IL-6 everywhere in the mouse brains.

That surprised them because IL-6 isn't found in brains of healthy animals.

In the mouse brains, IL-6 was found in astrocytes, which are supporting structures on the outside of brain cells that help connect the brain cells to transmit nerve signals. The researchers say the astrocytes in the mouse brains started making IL-6 after the mice were infected with the virus.

Identifying factors that protect brain cells may help find ways to fight diseases such as Alzheimer's disease (news - web sites) and Parkinson's disease (news - web sites).

More information

Here's where you can learn more about neurons.

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THURSDAY, JANUARY 9, 2003 

Irregular Heartbeat Gene Is Found

 

The Associated Press

Thursday, January 9, 2002

SEATTLE - A gene mutation linked to atrial fibrillation, a type of heartbeat irregularity, has been identified by researchers who studied four generations of Chinese family with a history of the disorder.

In a study appearing this week in the journal Science, Chinese and French researchers report that a mutation on a gene called KCNQ1 is the apparent cause of an inherited form of atrial fibrillation.

Atrial fibrillation affects more than 5 percent of everyone over the age of 65. The disorder lowers the pumping efficiency of the heart. It can cause blood clots, other types of heartbeat irregularities and heart failure.

To find the gene, researchers performed genetic screening on 44 members of a Chinese family with a history of atrial fibrillation. Sixteen of the family members were diagnosed with the disorder, some developing it at a young age. The family members lived in both rural villages and cities in Shandong Province.

Researchers found a mutation in the KCNQ1 gene among the affected family members, but not in those without the arrhythmia. They also screened 188 healthy, unrelated people and did not find the mutation.

Analysis of the gene mutation in laboratory cells showed that the gene disrupted the flow of potassium through cell membranes in the heart. Potassium plays a key role in the heartbeat.

Finding genes that cause a disorder can lead to a better understanding of its cause which, in turn, helps scientists to develop new therapies.

The 20 co-authors of the study Science are from five research centers in the People's Republic of China and a drug research center in France.

On the Net:

Science: www.sciencemag.org

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Baby Boys at Greater Risk Than Girls During Birth 

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - A new Dutch study suggests that labor and delivery may be more risky for male fetuses than for females.

In an analysis of more than 400,000 births in the Netherlands from 1990 to 1994, male fetuses were significantly more likely than females to experience so-called fetal distress. When a fetus goes into distress because of a lack of oxygen, immediate delivery may be necessary.

After researchers took into account birth weight and whether or not a fetus was premature, males had a 48% higher risk of fetal distress than females.

The results of the study were published in the December issue of the American Journal of Obstetrics and Gynecology (news - web sites).

Dr. Dick J. Bekedam, of the Onze Lieve Vrouwe Gasthuis in Amsterdam, and colleagues also found that males were 27% more likely than females to die shortly before or after birth (2.3% of boys, 1.7% of girls) or to score poorly on a scale used to evaluate a newborn's health.

Researchers are not sure why boys seem to be at higher risk than girls.

For the time being, the findings should not alter the care given during labor and delivery, according to Bekedam and his colleagues. If new methods of predicting fetal distress are developed, however, the researchers suggest that the sex of a fetus might be useful information.

Source: American Journal of Obstetrics and Gynecology 2002;187:1605-1607.


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Folic Acid Intake Tied to Colon Cancer Risk 

By Stephanie Riesenman

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - A diet containing little alcohol that is rich in folate sources like green leafy vegetables, fruits and whole grains may lower the risk for colorectal cancer, according to researchers in Italy.

In a study of 1,953 patients with colorectal cancer and more than 4,000 disease-free patients, researchers found an association between the amount of folate in the diet and the risk of cancer. Dr. Carlo La Vecchia, the study's lead author, said the incidence of the disease was 40% higher for patients who were heavy drinkers and had diets deficient in folate and the essential amino acid methionine.

"The results are not surprising," La Vecchia told Reuters Health, "and in broad agreement with other findings from North America."

In the study, published in a recent issue of the International Journal of Cancer, La Vecchia and colleagues gave food questionnaires to patients with colon or rectal cancer who were admitted to hospitals throughout Italy. Patients admitted to the same hospitals for conditions unrelated to digestive tract disease were also given questionnaires. They were asked to list the types of food they ate and how much alcohol they consumed daily.

After comparing results from the surveys, those with diagnosed colorectal cancer tended to have diets containing less folate and methionine, and were heavier drinkers than patients who were cancer free. Light drinking meant less than one glass of wine daily, while heavy drinking was equivalent to at least two 12-ounce beers a day.

The main sources of folate in the Italian diets were green leafy vegetables, whole grains, and liver. Orange juice, beans and peas are also good folic acid sources.

Methionine levels were studied because the amino acid plays a key role in regulating the availability of folic acid in the body. Previous studies have shown that high levels of methionine reduce colon cancer risk in people with a family history of the disease. Meat, fish, beans, eggs, garlic and sunflower seeds are all natural sources of methionine.

In the current study, the researchers noted that low levels of methionine were slightly associated with colorectal cancer, but the combination of low methionine and low folate had an even stronger association with cancer risk.

Other studies have looked at the impact of eating fruits and vegetables on polyp development and proliferation. Polyps are intestinal growths that can eventually develop into colon cancer. Researchers suspect that folate may protect against certain cancers, such as breast and colon, due to the nutrient's role in DNA synthesis and repair.

La Vecchia said the main public health message from this study is that people should "avoid drinking more than one or two drinks of alcoholic beverages a day," exercise regularly, and eat a balanced diet with "lots of fruits and vegetables."

Source: International Journal of Cancer 2002;102:545-547.


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Study Looks at Cod Liver Oil, Babies' Iqs 

By Suzanne Rostler and Stephanie Riesenman

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - Pregnant and breast-feeding women who supplement their diets with cod liver oil may help boost their children's intelligence, according to new study findings. But a leading US consumer advocate and physician argues that the study was too flawed for any conclusions to be drawn about the effects of cod-liver oil.

"There's too many problems with the study to reach any conclusion at all," Dr. Sidney Wolfe, director of the Washington, DC-based Public Citizen's Health Research Group, told Reuters Health.

The study is ongoing and researchers will test intelligence again when the children are 7 years old.

A type of omega-3 fatty acid known as docosahexaenoic acid (DHA) is crucial for the development of the central nervous system. It is theorized that pregnant and breast-feeding women who consume such fatty acids might improve the intellectual potential of their children, particularly during the third trimester and in the first three months of life, when the brain undergoes growth spurts.

To investigate, researchers gave more than 300 women either cod liver oil or corn oil supplements in their 18th week of pregnancy. The women took the supplements daily until their infant was 3 months old. There were no other differences in nutrient intake as a result of the mothers' usual diets.

According to findings based on 84 infants, children born to mothers who took cod liver oil supplements scored higher on intelligence tests measuring problem solving and information processing at 4 years of age.

The study is published in the January online issue of Pediatrics.

While more research is needed, the findings suggest that pregnant and lactating women should take the supplements since they are not associated with any negative side effects, Dr. Ingrid Helland, the lead investigator, told Reuters Health.

"Supplementing pregnant and lactating women with marine omega-3 fatty acids may increase their children's intelligence at 4 years," said Helland, from Rikshospitalet University Hospital in Oslo, Norway.

However, experts generally recommend that pregnant women avoid medications and supplements in pregnancy, unless the benefits have been clearly shown to outweigh the risks--as in the case of folic acid, which helps prevent birth defects. Women should consult their physician before taking any supplements during pregnancy.

The new findings support research showing that breast-fed infants may outsmart their formula-fed peers later in life, possibly as a result of compounds, including omega-3 fatty acids, found in breast milk. Last year, these compounds were added to infant formulas sold in the United States. Whether infants benefit equally from synthetic forms of these fatty acids is not yet clear.

It is also not known if cod liver oil taken during pregnancy would benefit infants who are fed formula, the researchers note.

Wolfe argued that 40% of parents in the study refused to have their children's intelligence tested, which could have produced a "huge" bias in the study because such parents may have thought their children had problems. Also, he added, results were not statistically significant for three of the four measures of intelligence that the researchers used.

While there is not likely to be an issue of mercury contamination with cod liver oil, as there is with certain other types of fish, Wolfe noted, any "potentially pharmacologically active" substance should be proven safe and effective in well-controlled studies before its use is recommended.

"It's not an unethical study, it just needs to be repeated to see whether it's (benefits are) really there or not, there's just too many methodological problems," he concluded.

Source: Pediatrics online 2003;111:e39-e44.


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School Problems in Diabetic Kids Not from Diabetes 

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - Despite some concerns over the effect type 1 diabetes might have on the brain, new research suggests that diabetic children who struggle in school likely do so as a result of factors other than their disease.

The chronic fluctuations in blood sugar levels that mark type 1 diabetes--along with the strains of managing a lifelong disease--have been associated with deficits in certain skills such as memory and verbal abilities.

But studies have yielded conflicting results in terms of which skills are affected, and whether any of these deficits hurt children's school performance has been unclear.

Recently, researchers found that children with type 1 diabetes performed as well as--and sometimes better than--their siblings and classmates on standardized academic tests. Their grades in math and reading were also comparable.

Now, in a new study, University of Iowa, Iowa City investigators have shown that differences in academic performance between diabetic and non-diabetic children stem mostly from other factors, such as family income and behavioral problems.

"The overall findings suggest the medical variables have less effect on academic achievement than do factors such as (family income) and behavior problems for most children with diabetes," the authors write.

Type 1 diabetes was once known as juvenile diabetes because it typically arises in childhood. It occurs when the immune system mistakenly destroys the insulin-producing cells of the pancreas. Insulin is a hormone that helps move sugar from the blood into cells to use as fuel.

Type 1 diabetics (news - web sites) must inject synthetic insulin daily--a regimen that often leads to wide fluctuations in blood sugar levels. It has been suggested that these highs and lows may hinder children's learning in school.

During the study, reported in the January issue of Diabetes Care, Dr. Ann Marie McCarthy and her colleagues examined standardized test scores, grades, behavior reports and absences in 244 students between 8 and 18 years old with type 1 diabetes. The researchers also looked at students' medical records, which detailed when they developed diabetes and other aspects of their conditions.

McCarthy and her team discovered that, contrary to previous suggestions, how well students did in school was more closely related to their behavior problems and family income than to the seriousness of their diabetes.

But not all aspects of their conditions were free from influence: the researchers also found that children who do a relatively poor job of keeping their blood sugar under control had lower reading scores and grades than other children. This finding remained even after McCarthy and her colleagues removed the influence of family income.

However, the researchers point out, this could mean that children who do better in school are also better able to manage their diabetes, suggesting that diabetes itself still may not affect school performance.

McCarthy and her team also discovered that children who end up in the hospital as a result of not managing their blood sugar properly tended to score lower on standardized tests than kids who control their blood sugar and are hospitalized less often.

The researchers also discovered that a small group of students who monitor their blood sugar closely and take small doses of insulin each day, but are hospitalized as a result of a drop in sugar levels, received particularly low scores on the standardized tests. These students may need special attention, McCarthy and her team note.

"Close monitoring of these high-risk children should be a priority in minimizing long-term cognitive effects of diabetes and its treatment," they write.

Source: Diabetes Care 2003;26:112-117.


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Web Surfers Searching for Diet, Heath Information

 

Reuters

Thursday, January 9, 2002

NEW YORK (Reuters) - Traffic to Internet sites in the health, fitness and nutrition categories jumped during the final days of December as Web surfers sought electronic help to fulfill the traditional year-end vows to lose weight and get in shape during 2003, officials said Thursday.

"Traditionally, we see a great deal of traffic to these sites toward the end of the year and just after the New Year as Americans gear up to tackle health and diet resolutions," said Lisa Strand, NetRatings analyst.

During the week ending December 29, more than 3.5 million people logged on to various health sites while cybersurfing at home, according to Internet measurement service Nielsen//NetRatings,

Leading this group, AOL Health attracted 805,000 different visitors during the week, NetRatings said. WebMD was second with an audience of 521,000.

The leader in dieting and weight management Web sites was eDiets.com, which drew 480,000 surfers and landed at the No. 3 spot.

Rounding out the list, Weight Watchers garnered 302,000 unique visitors for the week, NetRatings data revealed.

"In the health, fitness and nutrition category, eDiets.com and Weight Watchers enjoyed the biggest growth in traffic with 29 and 24 percent growth from the week before, respectively," Strand said.

NetRatings data from surfers trolling the Internet from home during the week ending December 29 showed that the New Year also brought surfers online for a cybersearch of what's to come in 2003.

The top two astrology sites attracted more than a million unique visitors. iVillage Astrology attracted a unique audience of 754,000, while MSN Astrology garnered 689,000 surfers in the same week.

Yahoo! Astrology claimed the No. 3 spot with 377,000 visitors.

Traffic to video game sites also spiked at home, with surfers flocking online for cheat codes to games they just received for Christmas.

Cheat Code Central took the top spot, with site traffic soaring 91% to 805,000 surfers, compared to 422,000 the previous week.

Traffic to Cheat Planet spiked 90% to 687,000, while PlayStation drew 368,000 unique visitors, jumping 69%.

Rounding out the top five fastest growing online games/video game platforms sites, GameWinners grew 67% to 882,000 unique visitors, while XBOX (news - web sites) drew 283,000 surfers for the week.

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CDC: Whooping Cough Outbreak in Illinois Adults 

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - Federal health officials are urging doctors to consider a diagnosis of whooping cough, or pertussis, in adults with a cough lasting two weeks or more.

"The number of pertussis cases in adults has risen substantially since the 1980s," according to researchers from the US Centers for Disease Control and Prevention (news - web sites) (CDC). While all children routinely get a pertussis vaccine, US cases have increased from 1,730 in 1980 to 8,296 in 2002--the highest number of reported cases since 1967.

An individual infected with Bordetella pertussis, the bacteria that cause pertussis, can experience a "whooping" sound as they inhale after a coughing fit, and may cough so hard that they vomit or faint. However, adults can have mild symptoms and might spread the highly infectious bacteria to babies, who are at greatest risk. About 0.8% of babies under six months of age who are infected with pertussis die of the infection.

Adolescents and adults may become infected with the bacteria because vaccine protection can wane 5 to 15 years after the last dose, the researchers warn. As a result, the CDC says pertussis vaccination "might have a future role in the prevention of disease and control of outbreaks in older age groups."

Typically, doctors will treat the infected patient with antibiotics and give antibiotics to close contacts to prevent infection.

In the CDC's Morbidity and Mortality Weekly Report, officials report a recent outbreak of pertussis among workers at an oil refinery in Illinois. Seventeen workers were diagnosed with pertussis and an additional 7 patients with pertussis were identified in the community. All 24 and 150 of their close contacts were effectively treated with antibiotics. No new cases have been reported since October.

Of note, pertussis was not initially considered in the original patient, who had a cough for 14 days, until the patient's supervisor also developed similar symptoms.

Source: Morbidity and Mortality Weekly Report 2003;52:1-4.


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Pricey Cigarettes Credited in Teen Smoking Decline 

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - Fewer New Hampshire teens are smoking now than just a few years ago, and health officials give part of the credit to a recent doubling of the price of cigarettes.

In 2001, one quarter of New Hampshire high schoolers said they currently smoked, down from 36% in 1995, according to state and federal health officials.

And only half as many 7th- and 8th-graders were smoking in 2001 compared with just the year before--about 6%, versus 12% in 2000.

The findings appear in the January 10th issue of the Morbidity and Mortality Weekly Report, published by US Centers for Disease Control and Prevention (news - web sites).

According to health officials, there are several possible reasons for the state's teen-smoking decline. One is the fact that cigarette prices in the state doubled between 1997 and 2001, thanks to a combination of industry price increases and state and federal taxes.

In 1997, a pack of cigarettes cost $1.77, while in 2001, the price tag was $3.53.

In addition, the report authors note, New Hampshire's tobacco-control program began in 1995 with federal funding. And although the state program was only funded at a "low level," they write, it did include efforts to start community anti-smoking programs and to begin "countermarketing" aimed at cigarettes.

Last year, New Hampshire expanded its anti-smoking program, owing to funds from the national tobacco settlement and other sources.

"When fully operational," the report authors write, "the program should hasten the decline in smoking among adolescents and begin to decrease prevalence among adults."

Source: Morbidity and Mortality Weekly Report 2003;52:7-9.


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High Blood Pressure May Get Start in the Womb 

By Amy Norton

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - New research supports the theory that some cases of high blood pressure may have roots that go back to fetal development.

What's more, researchers say, their findings suggest that proper nutrition during pregnancy could be a very early way to cut the risk of high blood pressure years later.

That's only speculation for now, but the new findings are in line with recent work suggesting that prenatal factors can have health effects that last into adulthood. There is evidence, for example, tying low birth weight to a higher risk of cardiovascular disease decades later.

This latest, small study now shows that people with primary hypertension--high blood pressure not caused by another disease--may have fewer nephrons in their kidneys than people with normal blood pressure do.

Nephrons are the tiny filtration units that do the kidneys' work of expelling waste and excess fluid from the body--a process that plays an important role in regulating blood pressure. The nephron number is set during fetal development, and a normal kidney is estimated to contain about 1 million nephrons, although that number varies among individuals.

The authors of the new study suspect that the lower nephron number they found in individuals with high blood pressure is the result of their having been born with a relatively lower number of nephrons.

The study cannot "definitely answer" this question, but past animal and human research has supported the concept that a low nephron number might leave a person more vulnerable to high blood pressure, Dr. Kerstin Amann told Reuters Health.

Amann, a professor at the University of Erlangen-Nurnberg in Germany, led the study. The findings are published in the January 9th issue of The New England Journal of Medicine (news - web sites) (NEJM).

Amann's team based their conclusions on examinations of kidneys from 20 middle-aged, white people, mostly men, who had died in accidents. Ten had had high blood pressure.

Although much more research is needed, these early findings point to the potential importance of prenatal nutrition in determining a person's eventual vulnerability to high blood pressure, according to Amann.

There is evidence, for example, that low protein intake during pregnancy could affect nephron number in the fetus, as well as the risk of high blood pressure and other types of cardiovascular disease in adulthood.

"Improving nutrition for pregnant women could be one strategy in preventing low nephron number and perhaps also hypertension," said Amann.

An NEJM editor agrees that good prenatal nutrition is "one possible preventive action."

However, high blood pressure has multiple risk factors, Dr. Julie R. Ingelfinger adds in an accompanying commentary.

"It would be an oversimplification to state that nephron number alone is the key to primary hypertension," she writes.

In addition, Amann pointed out, it is unknown if the current findings apply to different racial and ethnic groups. This is important because certain groups, including African Americans, have particularly high rates of hypertension.

Source: The New England Journal of Medicine 2003;348:101-108.


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More Evidence Light Drinking Cuts Heart Risks

 

By Alison McCook

Reuters Health

Thursday, January 9, 2002

NEW YORK (Reuters Health) - A study of almost 40,000 men adds to the growing body of evidence that drinking alcohol of any kind a few times each week can reduce the risk of heart disease. This new study demonstrates that whether your tastes lie in wine, beer, or liquor, any form of alcoholic drink confers the same advantages.

And drinking outside of meals appears to work just as well as drinks coupled with food, Dr. Kenneth J. Mukamal of Beth Israel Deaconess Medical Center in Boston, Massachusetts and his colleagues report in the January 9th issue of the New England Journal of Medicine (news - web sites).

However, Mukamal added his voice to the cries of caution from experts who note that regular drinking can also result in alcohol abuse, a life- and lifestyle-threatening problem.

"Heavier drinking, especially of large amounts at a time, is of no added benefit for the heart and potentially dangerous for other parts of the body," Mukamal told Reuters Health.

He noted that he cannot predict whether these results will apply to women, as well. If they do, Mukamal said the so-called "optimal" drinking level would likely be lower for women than for men.

Mukamal and his colleagues obtained their findings from following 38,077 men for 12 years, noting how much alcohol they drank and whether they developed heart disease. All men were heart disease- and cancer-free when the study began.

The authors asked participants about how much alcohol they consumed once every 4 years.

By the end of the study, 1,418 study participants had experienced a heart attack. "We found that men who drink relatively small amounts--say one drink on 3 to 4 days per week--are in the lowest risk group" for heart disease, Mukamal said, showing a 32% lower risk of heart attack than those who drank alcohol less than once a week.

In addition, increasing their drinking habits appeared to decrease their risk of heart problems. Men who said they had increased their habit by 12.5 grams of alcohol per day over a 4-year period--roughly equivalent to one serving of wine, beer, or liquor--also saw a drop in their risk of heart attack by 22%.

For example, men who increased their drinking during the study period from one to two drinks each day had a lower risk of heart attack.

Although heavy drinking is known to bring on a host of medical problems, Mukamal and his team discovered that men who downed more than 30 grams of alcohol per day saw a similar drop in heart problems as those who drank much less--even less than one daily drink.

In an interview with Reuters Health, Mukamal said that light drinking could promote heart health in many ways. For instance, he noted, alcohol can boost levels of high-density lipoprotein (HDL) cholesterol, a healthy form of cholesterol that can protect against heart disease.

Alcohol may also act as a blood thinner, preventing drinkers from forming potentially life-threatening clots. Mukamal added that recent research suggests that moderate drinking can improve the body's ability to process blood sugar, and may even reduce the risk of diabetes.

Still, although many studies now link light drinking to a healthy heart, these results only show an association, and not that one causes the other, writes Dr. Ira J. Goldberg of Columbia University in New York City, who wrote an accompanying editorial.

In addition, the toxic effects of drinking too much alcohol are well known, Goldberg notes. So while encouraging drinking could reduce heart problems, it may also lead to "thousands of additional deaths per year due to cancer, motor vehicle accidents, and liver disease," he writes.

As such, Goldberg notes that there is "insufficient information to encourage patients who do not drink alcohol to start."

One of Mukamal's co-authors, Dr. Eric B. Rimm of Harvard University in Boston, Massachusetts, has received speaking fees from the Distilled Spirits Council and Beverage Wholesalers.

Source: The New England Journal of Medicine 2003;348:109-118,163-164.


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Fears Raised Over Possible Mutant Mumps in Britain

 

By Pat Hagan

Reuters Health

Thursday, January 9, 2002

LONDON (Reuters Health) - A public health doctor has uncovered what he believes may be evidence of a mutant mumps virus circulating in Britain.

Dr. Brendan Crowley, from Liverpool Public Health Laboratory, said two recent unusual cases of mumps infection raise the possibility that a new strain has developed that may be resistant to the current mumps vaccine.

In a report in the journal Communicable Disease and Public Health, Crowley suggests the emergence of mutant forms of the virus could account for some of the recent resurgence in mumps infection in the UK. He also believes it's possible that, after years of exposure to the strain used to make mumps vaccines, this mutant form may have learned to evade detection by the body's immune system.

The report describes the case of a mother and son who both developed the infection, even though earlier tests confirmed she was immune and her 11-year-old child had already been vaccinated or infected.

"I'm just putting this idea forward because there was something very different about the strain involved," he told Reuters Health in an interview. "We need to ask whether it is possible it could be a mutant strain."

Mumps was once a common infection in Britain and is characterized by swelling of the lymph nodes on the side of the neck, making the face look round and swollen.

In many cases, the infection is mild but it can also cause fever, headache and muscle pains. In the worst instances, it can lead to deafness and inflammation of the testicles, ovaries or pancreas.

Before vaccinations were introduced, it was also one of the leading causes of life-threatening viral meningitis in children.

Over the last 18 months, there have been a number of mumps outbreaks, mainly involving teenagers who missed out on the measles, mumps, rubella vaccine when it was introduced in 1988 or failed to get enough doses of single mumps vaccine to develop immunity.

The latest figures from the Public Health Laboratory Service show there were 131 cases of mumps in England and Wales in the first quarter of 1992, the last period for which figures are available, compared to 115 in the same quarter of 2001.

Around 70% of the cases involved teenagers born between 1983 and 1990.

Crowley raised the alarm after discovering "an unusual antibody response" in the mother of the infected child.

The 11-year-old boy had been admitted to hospital, where doctors confirmed mumps infection and discharged him after a short course of treatment. Ten days later his 44-year-old mother developed facial swelling, which her doctor confirmed was also mumps.

Blood tests showed the boy had either been vaccinated or infected already, which should have meant he had some protection against reinfection.

Meanwhile, the mother, a healthcare worker, had given a blood sample a year earlier that showed she too was carrying mumps antibodies, probably as a result of earlier infection.

"I was really surprised because when we tested the mother's first blood sample for antibodies it was positive," Crowley told Reuters Health. "She should have been immune to mumps but she still developed the symptoms."

Further tests also showed her immune system responded completely differently to the virus than her son's--even though they were infected with the same strain. She produced high levels of antibodies to a strain of mumps known as the G genotype--which is not included in the current vaccine.

"It may simply reflect genetics because people vary in their response to viral infections. But it's also possible there's something very different about this strain," Crowley said.

"The G genotype is one that's only appeared in the last seven or eight years and it's certainly not in the vaccine strain."

Dr. Mary Ramsay, consultant epidemiologist at the Public Health Laboratory Service, said there was no evidence that mutant mumps strains were responsible for the rise in cases.

However, she said it is possible there are mutant strains circulating that are not particularly virulent and cause very few infections.

"There will always be some element of mutation in a virus. What matters is whether it persists in the general population and that does not seem to be a problem with this infection."

Source:: Communicable Disease and Public Health 2002;5:311-313.


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WEDNESDAY, JANUARY 8, 2003 

Frequency of Alcohol Use Cuts Heart Risks

 

By Janet McConnaughey

Associated Press Writer

The Associate Press

Wednesday, January 8, 2003

Scientists know drinking can prevent heart attacks, but new research shows that how often you imbibe is a lot more important than what or how much.

As little as half a drink every other day is enough to reduce the risk, regardless of whether it is beer, red wine, white wine or liquor, the study indicates. Whether you drink it with your meal or at some other time also appears irrelevant.

"It was a surprise that — almost regardless of other factors associated with drinking — frequency of use seemed to be what reduced the subsequent risk of a heart attack," said Dr. Kenneth Mukamal of Harvard University Medical School, who led the study.

Those who drank at least three days a week had about one-third fewer heart attacks than did non-drinkers. And it made almost no difference whether the drinking consisted of half a drink or four. Those who imbibed only once or twice a week had only a 16 percent lower risk of a heart attack.

Some studies have indicated that alcohol raises the level of "good" cholesterol and also thins the blood, warding off the clots that cause heart attacks. But alcohol breaks down fairly rapidly in the body and its effects on red blood cells are short-lived, according to Mukamal.

Mukamal speculated that regular, moderate drinking is beneficial because it helps keep the blood thinned.

"We think it may be much like people who take aspirin every day or every other day. A little bit of alcohol on a regular basis helps keep the platelets from becoming sticky and prevents heart attacks," he said.

He noted that other studies have found that people with a gene that keeps alcohol longer in their system seem to benefit the most from moderate drinking. "That helps reinforce the notion that maintaining a low level of exposure is the way to go," he said.

The study was published in Thursday's New England Journal of Medicine (news - web sites).

Mukamal and other doctors emphasized that the study applies only to moderate drinkers. The dangers of heavy drinking are well-established and include alcoholism, drunken driving, and damage to the liver and brain. Studies have also found that women who have two or more drinks a day are 41 percent more likely to develop breast cancer (news - web sites) than women who do not drink.

"I don't think any doctor would advise a patient to start drinking to prevent heart disease," said Dr. Gary Francis, director of the coronary intensive care unit at the Cleveland Clinic.

"We all, both the media and physicians who see patients, need to be careful that this isn't construed as a license to drink heavily. Certainly we don't want to exchange one public health problem for another."

Mukamal and every other doctor interviewed for comment emphasized that people should talk to their physicians about drinking.

Doctors have long believed that red wine explains the so-called French Paradox — the fact that the French have fewer heart attacks than Americans even though their food is richer. But the new study adds to the evidence that it is the alcohol itself, and not something found only in red wine, such as red pigment, that is good for the heart.

Mukamal analyzed data from a long-term study of 51,529 male health professionals — doctors, osteopaths, dentists, optometrists, podiatrists and veterinarians. He looked at 38,077 of them, eliminating people who had stopped drinking within the previous 10 years and those with histories of cancer and diseases of the heart or blood vessels.

Dr. Lynn Smaha, a cardiologist in Sayre, Pa., and a past president of the American Heart Association (news - web sites), said the study leaves some important questions unanswered. Among them: whether it would apply to a wider group than health professionals, who may take better care of themselves than the average drinker.

Smaha also noted that the overall rate of heart attacks — 1,418 cases out of 38,000 people — was very low, for reasons that were not clear.

He said he will continue to be very cautious in what he tells his patients about drinking.

And he worried about how some drinkers might interpret the study: "I can see the scene in a bar: `The paper says I should drink more. Where are my keys?'"

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Many Smokers, Binge Drinkers Don't Get Doc's Advice 

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - Millions of smokers and binge drinkers are missing out on a dose of healthy advice from their doctors about overcoming their unhealthy habits, new study findings show.

"Tobacco and alcohol are recognized as the first and third leading avoidable causes of death in the United States, accounting for approximately 430,000 and 100,000 deaths respectively, in 1990," according to the report published in the January issue of the American Journal of Preventive Medicine.

In the new study, lead author Dr. Clark H. Denny of the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Georgia, evaluated data from a 1997 telephone survey conducted in 10 US states. The survey included 3,818 smokers and 1,783 binge drinkers, defined as having consumed 5 or more drinks on at least one occasion during the previous month.

Of the smokers, 70% who had gone for a routine check-up in the past year reported that a health professional had advised them to kick the habit.

"Women were more likely than men, and adults aged (55 years or older) were more likely than those aged 18 to 34 years, to be advised," the authors write.

Among binge drinkers who had check-ups in the past year, 23% reported being advised to curb their drinking by a health professional. Doctors were more likely to speak up about binge drinking to men compared to women, and were more likely to counsel blacks than whites.

In the 10 states combined, Denny's team found that nearly 2 million smokers and slightly more than 2 million binge drinkers who had gone for a routine check-up in the past year were not encouraged to either quit smoking or drink less alcohol.

The findings are "especially disappointing because both brief counseling by health professionals for smoking cessation and reduction of alcohol use among problem drinkers have shown to be effective," the authors conclude.

Source: American Journal of Preventive Medicine 2003;24:1-4.

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Some Born With High Blood Pressure Risks

By Janet McConnaughey

Associated Press Writer

The Associate Press

Wednesday, January 8, 2003

Some people appear to be born at risk for high blood pressure, with far fewer filters than normal in their kidneys, a study found.

Doctors do not know how big a role is played by this kidney condition, which occurs when a mother doesn't eat enough protein. Nevertheless, the small German study raises the possibility that for some, susceptibility to high blood pressure begins before birth.

Dr. Leslie Spry, a spokesman for the National Kidney Foundation, said the study offers the first anatomic evidence in people to back up a long-standing theory.

"I would have been a little bit of a doubter that they would find something like this," Spry said. But "it's very carefully done, very carefully documented, and it's quite believable."

The study, which appears in Thursday's New England Journal of Medicine (news - web sites), was conducted by Kerstin Amann of the University of Erlangen-Nurnberg, and colleagues there and at the University of Heidelberg and City Hospital of Darmstadt.

The researchers found 10 men who had died in accidents and had had high blood pressure. Each was matched with another accident victim of the same age, sex, height and weight who had not shown any sign of hypertension.

Painstaking counts found that the kidneys of the healthier people had two to three times more filters — twisted masses of blood vessels called glomeruli — than their counterparts with high blood pressure.

The filter count ranged widely in healthy kidneys, but the midpoint total was 1.4 million, double that in the hypertensive kidneys. The filters in the hypertensive kidneys were also much bigger, an indication of overwork.

"This is certainly another piece of the puzzle that falls into place to make us more comfortable that we are on track to understanding the cause of hypertension," said Dr. Dan Jones, associate vice chancellor at the University of Mississippi Medical Center.

Spry said he would like to see a similar study among blacks, who for unknown reasons are more likely than whites to have high blood pressure. Fewer glomeruli could be one explanation, he said.

The study also indicated that the best treatment for hypertension may be a combination of older drugs called diuretics and newer medicines that lower pressure within glomeruli, he said.

"If one conceptualizes that people with high blood pressure have big, old, fat glomeruli and not many of them, it stands to reason these big, fat glomeruli are under pressure," Spry said. "The good news is we have very good medicines to lower pressure within the glomeruli" — ACE inhibitors and angiotensin II receptor blockers.

Amann said the findings also highlight the importance of diet during pregnancy, because a pregnant woman who does not get enough protein is likely to have a baby with fewer kidney filters.

"This is perhaps the only definite knowledge we have" about potential causes, she said.

On the Net:

National Kidney Foundation: http://www.kidney.org

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FDA: Hormone Therapy Drug Labels to Change 

By Keith Mulvihill

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - The US Food and Drug Administration (news - web sites) announced Wednesday that makers of estrogen-containing products that are used by women for menopause symptoms will be required to make label changes reflecting new safety concerns.

In addition, women who do decide to take the drugs are being advised to take the lowest dose for the shortest possible time.

The announcement comes six months after a US government-sponsored study, the Women's Health Initiative (WHI), was halted three years earlier than expected. The landmark study found that women taking a hormone replacement product had a slightly higher risk of heart disease, breast cancer (news - web sites), stroke and blood clots compared with women not taking the hormones.

In that study, women were taking the drug Prempro, a combination of estrogen and progestin. Another arm of the WHI, in which women are taking an estrogen-only product called Premarin, is ongoing. Women who still have a uterus typically take estrogen combined with progestin, while those who have had a hysterectomy take estrogen alone.

Shortly after the WHI was halted, Wyeth Pharmaceuticals made some labeling changes and the new labeling will affect the company's estrogen-containing products--Prempro, Premphase and Premarin. The FDA is also asking all other manufacturers of estrogen or estrogen/progestin products to make similar changes as well.

"Today the FDA is taking action to provide new advice to women who use or are considering using estrogen or estrogen with progestin," said the FDA's Commissioner Dr. Mark B. McClellan.

"Now a box warning about not using estrogens for cardiovascular protection and about the findings of the WHI has been added to these products," McClellan told attendees of a press conference.

Although the FDA never approved the drugs for heart disease prevention, many doctors prescribed the drugs "off label" because there was preliminary evidence that the drugs might be helpful.

Patient information that accompanies the products will be revised to reflect the new changes.

"Different estrogens and progestins are believed to act similarly, and in the absence of data suggesting otherwise, women need to assume that the risk of other estrogens and progestins are similar," said McClellan.

A labeling guidance policy will be published shortly for the manufacturers of these drugs, according to the FDA.

Currently there are three FDA-approved indications for the use of Prempro, Premarin and Premphase. One is the treatment of hot flashes and night sweats, two common symptoms of menopause. "This indication and the FDA labeling has not changed," said McClellan.

The two other indications have been revised, said McClellan.

While the drugs are still recommended for moderate to severe vulvar and vaginal atrophy symptoms, "we now state the when prescribing for solely the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered," McClellan said.

Although HRT drugs can still be prescribed to prevent the bone-thinning disease osteoporosis. the label will say they "should only be considered for women at significant risk for osteoporosis and nonestrogen treatments should be carefully considered," he said.

There are now several different drugs on the market for patients at risk for osteoporosis, including a class of drugs called bisphosphonates.

The FDA will continue to study whether low doses of the estrogen/progestin products are safer than higher doses, and compare the safety profiles of different types of products that contain the hormones.

Above all, a woman who uses or is considering using estrogen-containing products should consult her doctor regarding the individual risks and benefits of the hormones, McClellan said.

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Self-Contained Heart Implanted in Ky.

The Associate Press

Wednesday, January 8, 2003

LOUISVILLE, Ky. - Doctors at a Louisville hospital have implanted a self-contained artificial heart in a critically ill patient, the eighth such surgery in the United States but the first since April.

Only one of the previous patients — Tom Christerson of Central City, Ky., who received his heart in September 2001 in Louisville — is still alive.

The latest surgery took place Tuesday, Jewish Hospital said in a statement Wednesday. The hospital said it would not release the patient's name or other details at the request of the family.

Robert Tools of Franklin, Ky., was the first to receive the self-contained heart, a softball-sized pump made of plastic and titanium and powered by batteries. It has no wires or tubes sticking through the skin, a technological leap from earlier mechanical hearts that were attached by wires and tubes to machinery outside the body.

Tools received the heart July 2, 2001, and lived five months.

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Seasonal Depression, Bulimia Linked in Japan Study 

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - People suffering from bulimia--a form of eating disorder in which people binge eat, then purge themselves by vomiting or taking laxatives--tend to also be more likely to experience episodes of depression that vary with the seasons, according to small study conducted in Japan.

Among 30 Japanese people with bulimia, the researchers found that more than 40% experienced seasonal patterns of mild or serious depression. In contrast, only 10% of people without the eating disorder showed similar seasonal variations in their mood.

Periods of depression that come and go with seasons are part of a condition known as seasonal affective disorder, or SAD.

People with SAD get depressed at certain times of the year, usually in the fall and winter. Debate continues on why, but whatever the cause, basking in bright light is known to lift the mood of people with SAD.

Given the link between bulimia and SAD, the study authors suggest that the light treatment that alleviates SAD may relieve the symptoms of bulimia, as well.

Dr. Masaki Yamatsuji of the Osaka Dai-ichi Hospital in Osaka City and colleagues obtained their findings from questionnaires sent to 90 people diagnosed with an eating disorder who were living in Kyoto. All but 2 of the respondents were female.

The questionnaires asked respondents about seasonal variations in their mood and other qualities, such as levels of social activity, sleep, appetite and energy.

A total of 50 respondents had some type of anorexia, 30 were bulimic and another 10 had an unspecified eating disorder.

The researchers also distributed the questionnaire to 96 female nurses who were free from eating disorders.

Only people with bulimia, and not those with other eating disorders, appeared to show higher-than-average symptoms of SAD, the authors report in a recent issue of the International Journal of Eating Disorders.

Other studies have linked abnormal eating in patients with eating disorders to seasons in Japan, Yamatsuji and colleagues note, showing that binge eating tends to increase in winter while anorectic symptoms often begin to rise in the spring and summer.

Previous research has also shown that people living in Japan experience seasonal variations in mood, but to a lesser extent than residents of the US and Europe. Yamatsuji and colleagues suggest that more bulimics in Japan experience a relatively mild form of SAD than those living in North America.

Nevertheless, "light therapy may be useful for (bulimia) patients in Japan as well," they note.

Source: International Journal of Eating Disorders 2003;33:71-77.

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W. Virginians Worry About Health Care

By Joedy McCreary

Associated Press Writer

The Associate Press

Wednesday, January 8, 2003

WHEELING, W.Va. - You can see Wheeling in Kenneth Dewitt's face — stoic and rugged, a reflection of the region's steel- and nail-manufacturing history.

But Tuesday the hard exterior was cracking.

Dewitt's wife is being treated for cancer by one of the two dozen surgeons in West Virginia's Northern Panhandle who have taken leave to protest the cost of medical malpractice insurance.

"It seems like the right thing to do, while on the other hand, they're jeopardizing people's health," he said as a tear trickled down his cheek. "I suppose this is what they have to do. ... Now, the thing is, what do the people do?"

In a region that has historically supported organized job actions, many residents support the doctors' efforts — until they're the ones worried about their treatment.

Surgeons at four hospitals began a 30-day walkout last week, halting elective surgeries.

Dr. Donald Hofreuter, president and chief executive officer at Wheeling Hospital, said during a town meeting Tuesday night that physicians at his hospital weren't effective before the walkout because they feared lawsuits.

"If an athlete is running the football and he's afraid of being hit, he's not as effective as you want him to be," Hofreuter said.

The relationship between doctor and patient, he said, "is almost adversarial. They look at a patient as a potential lawsuit."

Wheeling attorney T.C. McCarthy blamed insurance company St. Paul for a failed investment strategy and for trying to pressure hospitals.

"When their market investments went down, their investment returns dropped," McCarthy said. "The only way to make up for it was to prop up their premium charges. Doctors are being squeezed."

Insurance representatives were not present at Tuesday's town meeting, which was attended by about 100 residents. St. Paul officials did not return a call for comment Tuesday.

Wheeling attorney Bob Fitzsimmons has created a $25,000 Abandoned Patients' Strike Fund, which will be used to reimburse transferred patients' expenses. The money was donated by lawyers and by medical malpractice victims, he said.

"This got started because of the desperate need for some financial help for the patients that the doctors have turned their backs on," Fitzsimmons said Tuesday.

But Linda Byrum, a teacher who attended Tuesday's town meeting, said people should blame attorneys who focus on malpractice cases, not the doctors.

"The sad fact is, people seem to say 'But (doctors) are so wealthy,'" Byrum said. "That's so one-sided, such an uneducated view. The public needs to be educated as to what the problem really is."

Protesting doctors are transferring some patients to facilities elsewhere in the state and in Ohio and Pennsylvania. Some have returned to their West Virginia hospitals, but only to perform emergency surgeries.

"We're not abandoning any patients," said Dr. David Ghaphery, one of the protesting doctors. "Our beepers are on. We're not wanting anyone to suffer. Our goal with this is to bring public light to the situation."

Doctors, who blame jury awards for their high premiums, are pushing Gov. Bob Wise and the state Legislature for assistance.

Doctors say they're seeing more patients than usual in their offices. With fewer surgeries scheduled, they have more time for office visits.

"That has kept patients supportive because they don't feel abandoned," said Dr. Stephen Wiley, a protesting surgeon, who said he sees between 15 and 25 patients each day in his office.

Many surgeons will gather to watch Wise's State of the State address Wednesday night. But Ghaphery said there aren't any magic words to bring the doctors back to work.

"I would be more confident if they passed something, rather than if they promised something," Ghaphery said. "They've been saying for years that they would pass something, but it keeps getting worse."

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Toddlers' Pacifier Type Won't Halt Dental Problems 

By Stephanie Riesenman

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - Pacifiers sold as "orthodontic" are no better than traditional pacifiers when it comes to warding off dental problems in children who continue a sucking habit beyond the age of three, say researchers in Brazil.

"It's very common for a child to suck on a pacifier; it's almost a universal habit, but by 24 to 28 months the majority have stopped, and those who continue might develop dental problems," Dr. John Warren of the University of Iowa said in an interview with Reuters Health. Warren, who was not involved in the study, is an assistant professor in the dental school and has conducted similar studies.

In the study of 61 Brazilian (news - web sites) preschool children, who were three to five years old, the habitual pacifier suckers had a higher prevalence of altered dental arches and abnormal lip and cheek mobility compared to toddlers who never sucked on a pacifier. There was no benefit for kids who used an orthodontically designed pacifier, which has a concave nipple designed to simulate the shape of a mother's nipple, rather than a traditional round pacifier.

Some studies have shown that children who suck on orthodontic pacifiers have a smaller chance of developing an overbite than those who use conventional round pacifiers. A spokesperson for Gerber, one of the companies that sells orthodontic pacifiers, said that the pacifier was "designed to simulate the form and function of a mother's breast nipples while feeding," but made no claims about the pacifier's ability to prevent an overbite.

The Brazilian study, conducted by Dr. Cristina Giovannetti del Conte Zardetto and colleagues at the University of Sao Paulo, was the first to compare children who had exclusively used either an orthodontic pacifier or a traditional pacifier. Any child who had ever sucked their fingers or thumbs was excluded from the study.

Mothers were provided with questionnaires to assess their child's pacifier use. The survey did not address pacifier size or the number of hours a day that it was in a child's mouth. A single examiner was brought in to measure and describe the children's dental arches and bite. A speech therapist examined the physical structure of the mouth and had the children perform different exercises to verify lip, cheek and tongue mobility, according to the report in the journal Pediatric Dentistry.

Warren said the action of sucking on a pacifier, whether it's an orthodontic design or traditional model, draws a child's cheek muscles tighter, which inhibits the growth and width of the upper jaw. A pacifier also tends to push a child's tongue down into the lower jaw, so they end up with a cross-bite, or a wider than normal arch between the bottom teeth.

Oversized dental arches are usually reversible if the child stops sucking on a pacifier, said Warren, but the longer they put something in their mouth the less likely the problems will resolve. If a child stops using a pacifier at the age of two, Warren said their dental arches will usually go back to normal.

"Probably about a year of age is when parents should start to wean them off," said Warren. "Somewhere between their first and second birthdays would be ideal."

Many dentists recommend that parents pick a target date for their child to get rid of a pacifier. Warren says it shouldn't be a birthday or major holiday, but make it an important day for the child, and stick to the deadline. He said the older a child becomes, the harder it is to break the pacifier habit.

Source: Pediatric Dentistry 2002;24:552-559.

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Hold the Pickles, Add the Peppers

HealthScoutNews

Wednesday, January 8, 2003

WEDNESDAY, Jan. 8 (HealthScoutNews) -- Adding cayenne pepper, sweet peppers and tomatoes to beef burgers can prolong their shelf life and reduce the need for artificial preservatives, says a Spanish study in the February issue of the Journal of the Science of Food and Agriculture.

Researchers at the University of Zaragoza created eight batches of beef burgers. Each batch contained varying amounts of cayenne pepper, red sweet pepper and lycopene-enriched tomato products.

The researchers stored the beef burgers at 20 degrees C and then tested them every four days for microbial activity, sensory analysis, color analysis and pH.

The study found the addition of ground cayenne and sweet peppers to the beef burgers greatly inhibited the oxidation of both myoglobin and lipids and the growth of psychotropic bacteria. The shelf life of the burgers with the peppers was extended from four days to about 16 days.

The researchers concluded that adding lycopene-rich tomato products wasn't as effective, but still extended the burgers' shelf life to between eight and 12 days.

More information

Here's where you can learn more about food safety

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FDA OKs Method to Boost Dairy Product Shelf Life 

Reuters

Wednesday, January 8, 2003

DALLAS (Reuters) - Dean Foods Co., the largest US dairy, said on Wednesday it won government approval for a new technology that gives dairy-based beverages a six-month shelf life.

The Dallas-based food and beverage company, formerly Suiza Foods, said its Morningstar Foods division had received aseptic approval from the US Food and Drug Administration (news - web sites) for beverages produced on its Stork filler line in Mount Crawford, Virginia. The Stork bottle-filling technology extends the shelf life of dairy-based beverages to 180 days and allows the products to be stored and shipped at ambient temperatures.

Dean said it is the first company to use the Stork plastic bottle technology commercially for dairy-based beverages in the United States.

"Gaining FDA approval will enable us to further expand our distribution beyond traditional refrigerated channels for these products," Chairman and Chief Executive Gregg Engles said in a statement.

The Morningstar unit plans to use the Stork technology to process its single-serve Hershey's flavored milk and shake products and its Folgers Jakada coffee beverages at the Virginia facility. It plans to install a similar line later this year at its facility in City of Industry, California. Dean said the Stork aseptic technology includes pasteurization, homogenization and other procedures conducted in a sterile environment that earns the aseptic designation without the need for additives or preservatives.

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Study Finds Silver Lining for Hormone Therapy

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 8, 2003

WEDNESDAY, Jan. 8 (HealthScoutNews) -- After a spate of bad news about hormone therapy, new research offers a bit of good news: It reduces the risk of diabetes in postmenopausal women who have heart disease.

But no one, including the study's authors, are suggesting that hormone replacement therapy (HRT) be prescribed to reduce that risk. Rather, the report, which appears in this week's issue of the Annals of Internal Medicine, should trigger additional research, experts say.

In the study, Dr. Alka Kanaya, an assistant professor of medicine at the University of California at San Francisco School of Medicine, and her colleagues found that HRT, including estrogen and progestin, reduced the incidence of diabetes by 35 percent during the four-year follow-up in women who had undergone natural menopause and who already had heart disease.

About 16 million Americans have Type II diabetes, in which the body fails to make enough insulin or to use it properly, according to the American Diabetes Association (ADA).

In the new study, Kanaya and her co-researchers zeroed in on a subset of women from the trial known as HERS (Heart and Estrogen/progestin Replacement Study), in which 2,763 women with documented heart disease were assigned to take HRT or a placebo. The main HERS conclusion, that HRT did not help prevent second heart attacks, was released in 1998.

In the newer study, Kanaya and her colleagues focused on the 2,029 women in the HERS trial who were free of diabetes at the outset. These women took either HRT or a placebo each day.

After four years, 160 of the women developed diabetes -- 62, or 6.2 percent, of those on HRT and 98, or 9.5 percent, of those on a placebo.

"We found that in [these] women with coronary disease, HRT reduces the incidence of diabetes by 35 percent," says Kanaya. The reduction held, she says, after controlling for such risk factors as obesity, which boosts the chances of getting Type II diabetes.

The study is definitely not a reason to consider HRT to reduce diabetes risk, Kanaya says, however. "The conclusion is that this is a scientifically interesting finding that needs to be confirmed, and that the risk of hormone therapy outweighs the benefits and that it's premature to recommend the use of hormone therapy to prevent diabetes," she adds.

Last summer, a national trial evaluating the benefits of HRT in healthy women was halted after experts determined women taking HRT were at increased risk for strokes and heart attacks but decreased risk for osteoporosis and colon cancer.

"Clinically, it should not change practice in any way," Kanaya says. The HERS trial was funded by Wyeth-Ayerst, which makes HRT.

This latest study is not the first to suggest that HRT helps reduce diabetes risk, Kanaya adds. "A lot of small studies have looked at the effect of hormone therapy on glucose levels," she says. "The data is extremely mixed."

"Our feeling is that HRT has a direct effect on the liver, and how the liver processes glucose," Kanaya says. "It's almost a protection against having too much glucose produced by the liver."

Even so, the researchers note in the report that the findings may not apply to all postmenopausal women; those in the study all had heart disease and all had undergone natural (not surgical) menopause.

In an editorial accompanying the study, another expert agrees that the finding should not change clinical practice and that further studies are needed to zero in on the effect of HRT on the processing of glucose.

"Future studies of HRT should investigate its effect on glucose metabolism more thoroughly," writes Dr. Peter W. F. Wilson, a professor of medicine at the Boston University School of Medicine.

To reduce the risk of Type II diabetes, the ADA suggests keeping weight under control and getting regular exercise. Diabetes increases the risk for heart problems, stroke and complications related to poor circulation.

What To Do

For more information on Type II diabetes, see the American Diabetes Association. For more on the hormone therapy trial that was halted, see the Women's Health Initiative.

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Mouse Study Reveals Second Serotonin-Making Gene 

By Keith Mulvihill

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - German scientists have identified a second enzyme that is involved in making serotonin, a brain chemical associated with depression. And the genetic hardware of this newly identified enzyme is detected primarily in the brain, according to their mouse study reported in the January 3rd issue of the journal Science.

The findings suggest that all past efforts to identify genetic reasons for mental disorders linked to abnormal serotonin production have focused on the wrong gene, according to Dr. Diego J. Walther of the Max Delbruck Center for Molecular Medicine in Berlin-Buch.

Walther's group believes their discovery may lead to new diagnostic and therapeutic approaches.

They point out that the existence of a second enzyme called tryptophan hydroxylase-2 (Tph2) was hypothesized in 1980, but up until now there has been no way to verify that claim.

Serotonin synthesis occurs in a handful of extremely important neurons in the brain and in some cells of the gastrointestinal tract, Walther explained in an interview with Reuters Health.

"This is common knowledge in the serotonin field, but it was believed for decades that only one enzyme commits the rate-limiting step in the biosynthesis in all tissues. However, we have discovered a second tryptophan hydroxylase enzyme," added the researcher. A rate-limiting step is the slowest step involved in a multiple-step chemical reaction; this step determines the rate at which a reaction occurs.

"Moreover, we were able to elucidate that this second enzyme is the source for serotonin in neurons, and not the formerly known enzyme (Tph-1), which we've found to synthesize serotonin most prominently in the gut of adult vertebrates," said Walther.

"Therefore, our findings (have) opened a door to a completely new research area, and to our understanding of the biosynthesis of a compound related to a multitude of mood-controlling effects," he added.

In the study, the investigators generated mice genetically deficient in Tph1. These mice lacked any serotonin outside the brain except in the duodenum, the part of the small intestine closest to the stomach, where levels were only about 4% of normal.

However, brain regions known to generate serotonin expressed normal amounts of the neurotransmitter in the mutant mice, and the animals exhibited behavior similar to that of non-mutant mice in tests associated with serotonin-related behavior.

Moreover, the RNA of a second enzyme, Tph2, was distinct from that of Tph1, according to the report. When examining total RNA from the brain stem of normal mice, they observed that Tph2 was expressed at levels 150 times greater than that of Tph1.

RNA is the working molecule that translates the genetic instructions of DNA into functioning cell proteins.

Source: Science 2003;299:76.

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The Nonphysician Will See You Now

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 8, 2003

WEDNESDAY, Jan. 8 (HealthScoutNews) -- In the 1990s, the rise of HMOs stoked fears that getting an appointment with a doctor would go the way of house calls -- a luxury not possible in a cost-conscious world.

Instead, doctors' groups warned, we'd be forced to seek treatment from lesser-trained nurse practitioners and physician assistants.

However, a new study finds those fears haven't come to pass. In fact, Americans are going to see more health-care providers of all types.

Between 1987 and 1997, the percentage of patients in the United States who visited nonphysician clinicians rose from 30 percent to 36 percent, says the study. Nonphysician clinicians include nurses, nurse practitioners, chiropractors, midwives, psychologists, social workers, physical or occupational therapists, podiatrists and optometrists. Their training is less rigorous, and they are likelier to face more regulation -- for instance, in prescribing drugs or performing invasive procedures-- than physicians.

That doesn't mean U.S. residents are seeing nonphysician clinicians instead of seeing a doctor with the more traditional education that led to an M.D.

Instead, patients increasingly sought care from both physicians and nonphysicians. Patients who saw both rose from 23.5 percent to 30.9 percent during the decade. And the percentage of people who saw only a nonphysician clinician actually declined, from 7.2 percent to 5.3 percent.

"These findings show how the health workforce has evolved during a time of great change in the U.S. health system," says Dr. Benjamin Druss, an associate professor of public health and psychiatry at Emory University in Atlanta. "Patients are increasingly treated by multiple providers who have a range of training and philosophical approaches to treatment."

The study appears in tomorrow's issue of The New England Journal of Medicine (news - web sites).

At the beginning of the 20th century, physicians accounted for about one in three health-care workers, according to an editorial in the same issue. By the early 1980s, that number had fallen to one in 16.

The dramatic increase in nonphysician clinicians, combined with the "corporatization" of health care that came with HMOs, was seen by some physicians as a threat to their livelihood, says Linda Aiken, author of the editorial and a professor of nursing and director of the Center for Health Policy Outcomes at the University of Pennsylvania.

The new research should be seen as good news for everyone, she says.

"It provides some very compelling evidence that many of the fears of providers and some consumers about the substitution of nonphysician clinicians for physicians were not borne out," Aiken says. "A natural balance seems to be developing, with consumers going to see nonphysician clinicians and retaining their physicians."

The change reflects the greater acceptance of nonphysician clinicians by both patients and physicians, Aiken says.

"The shift couldn't have happened without physician referrals," she says, "which probably reflects a greater recognition by physicians that nonphysician clinicians make an important contribution to health care."

The fact that more people are seeing varied health providers also reflects societal changes. Patients have increased their knowledge about health conditions, in part because of the Internet and other news sources willing to provide the information. The expansion of health insurance and greater disposable income is another reason. Still another factor is the shift in the burden of illness from acute to chronic conditions in an aging population, Aiken says.

As a result, patients seek help from medical professionals for a much wider range of problems. In the past, you might only see a doctor when you were sick, she explains. Now, Americans might seek help for everything from smoking cessation to depression to caring for the elderly to managing diabetes to child development issues.

"These things came to be defined as medical issues and nonphysician clinicians responded to that demand," Aiken says.

The study uses data from two national surveys of more than 40,000 adults interviewed in 1987 and 1997. It was a time of rapid change in the health-care system, Druss says. Examples include: more nonphysician clinicians graduating from training programs; new state laws giving nonphysicians greater autonomy; and the rise of powerful managed-care organizations.

"There had been a prediction that the increase in numbers of nonphysician clinicians and laws allowing them to practice autonomously would create a great deal of conflict with physicians," Druss says. "Physicians worried that it would put primary-care physicians out of work. We really didn't find that."

In fact, fewer nonphysician clinicians practiced independently between 1987 and 1999. It's more common now for physicians and nonphysician clinicians to share a facility, Druss says.

Part of this could be attributed to managed care.

"At its worst, managed care is designed to cut costs," he says. "At its best, it can provide a broader system of care that allows a greater collaboration of care."

What To Do

Find out more about nurse practitioners at the American College of Nurse Practitioners. The American Academy of Physician Assistants has more information about physician assistants.

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Blood Flow in Fetal Heart Key to Normal Development 

By Keith Mulvihill

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - Scientists who peered into the beating hearts of zebrafish embryos say that certain blood flow patterns in the organ are key to developing a healthy, normal heart. The same is most likely true for human embryos, according to one of the investigators.

"While the genetic program is essential in the proper formation of the heart, its control is influenced by local blood flow conditions and the forces they produce," the study's lead author, Dr. Jay R. Hove of the California Institute of Technology in Pasadena, told Reuters Health.

The investigators took advantage of the transparent nature of the zebrafish embryo and used a high-tech microscope to look through the embryo and into the beating heart without having to cut any tissue, Hove explained.

Their findings are published in the January 9th issue of the journal Nature.

"We know from studies of vascular development and atherosclerosis that the forces--such as pressure and shear stress--imposed by complex blood flow patterns influence the properties of the surrounding cells," said Hove.

"Thus both the form and function of vascular cells can be modified by blood flow patterns," added the researcher.

"A second, exciting result is the fact that we can really see inside a living, beating heart and very precisely map the blood flow," said Hove.

After measuring the velocities and patterns of the blood flow, Hove's team calculated the expected forces imposed on the heart chamber walls by the flowing blood. Both the rate of flow and the imposed forces were much higher than expected, Hove said, and the investigators felt this would likely influence the pattern and/or timing of the heart's development.

"To test that idea, we surgically blocked the incoming or outgoing blood flow and observed the effects on development of the organ," said Hove.

"We found that diminished flow, and thus diminished forces sensed by the vascular cells, resulted in drastically altered development in the chambers, valves and orientation of the heart. Many of these changes were similar to those seen in cases of congenital heart disease and in zebrafish with key developmental genes 'knocked out,"' Hove told Reuters Health.

Although fish and humans are not closely related, they are both vertebrates, noted Hove, and therefore the new findings are relevant to human heart development.

"Many of the fundamental developmental processes (including heart development) are strongly conserved through evolutionary time across a wide range of organisms," said Hove.

The same processes occur in fish, amphibians, reptiles, birds and mammals during early heart development, from early heart tube formation to the looping of the heart, according to Hove. After this, more evolved groups of animals have "further modifications not seen in the more ancestral forms," he said.

"So, in my opinion, the implications for human health are that the same fluid dynamic forces that affect the developmental program in zebrafish probably affect the way the embryonic/fetal human heart grows as well," Hove added.

"On a more futuristic line, one could imagine a world where we could surgically alter a defective heart as it develops, changing the defective blood flow pattern and allowing the heart to grow into a less deleterious geometry," the researcher speculated.

"But for now," he added, "this optimistic scenario remains in the realm of fiction."

Source: Nature 2003;421:172-177.

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A Nutritional Menu

HealthScoutNews

Wednesday, January 8, 2003

WEDNESDAY, Jan. 8 (HealthScoutNews) -- Dietary recommendations from self-proclaimed health gurus abound, but what do nutrition experts from the highly regarded Mayo Clinic choose when preparing lunches or dinners?

An article in the January issue of Mayo Clinic Women's HealthSource offers some clues. Here are a few of the experts' picks for favorite foods and why they recommend them:

·         Broccoli: The experts say broccoli contains a phytochemical that may prevent growth of cancer tumors and lutein, a powerful vision-protecting antioxidant. They recommend including broccoli in your menu two to three times a week.

  • Vegetables: Because they're high in nutrients and low in calories, vegetables can be a great choice if you're looking for volume. Consider this: One cup of vegetables is about 50 calories, while a cup of M&Ms is about 850 calories. The experts recommend eating vegetables every day.
  • Apples: How can an apple a day keep the doctor away? Here's how, say the experts: Since they're a good source of phenol antioxidants, they can keep the "bad" LDL cholesterol from getting oxidized, and oxidized LDL is bad for your arteries.
  • Soy nuts: They are a good source for protein and isoflavones, which may protect the heart and bones and reduce the risk of cancer.
  • Fish: Salmon and tuna, in particular, are high in omega-3 fatty acids. They taste great and can be prepared many ways. Eat a 3-ounce portion once a week.
  • Nuts: They are high in monounsaturated fat and are a great snack. Pistachios, in particular, are recommended for snacking and toasted almonds for salads.

More information

Visit the American Dietetic Association for much more nutritional information.

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Antibiotic Mist Might Treat Stubborn Sinusitis

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - Inhaled antibiotics could offer an alternative treatment for people with chronic sinus infections that resist standard therapy, a new pilot study suggests.

The study involved 42 adults with chronic sinusitis that persisted even after surgery to open the passages that drain the sinuses. Researchers found that antibiotics taken via nasal mist got rid of the infections 76% of the time, at least during the three months following treatment.

Patients also reported improvements in symptoms such as facial pain and postnasal drip--although 10 of the successfully treated patients did develop new sinus infections caused by bacteria different from the bacteria their antibiotics were directed against.

Sinusitis refers to infection and inflammation of the sinus cavities around the nose. The condition, which causes pain and tenderness around the eyes and cheeks, headache, congestion and other symptoms, may be caused by a viral or bacterial infection. When bacteria are to blame, antibiotics can be used to clear the infection.

For some people, however, sinus infections become chronic; those with allergies or asthma are particularly prone to this. Oral antibiotics and other medications can combat chronic sinusitis, but when drugs fail patients may need surgery to clear the sinus passages.

Those in the new study had all undergone surgery before they were offered three weeks' worth of inhaled antibiotics for their continuing bouts of new infections. Overall, after treatment the patients remained free of infection for an average of 17 weeks, according to findings published in the December issue of the journal Otolaryngology, Head and Neck Surgery.

Dr. Winston C. Vaughan, director of the sinus center at Stanford University in California, led the study. Vaughan chairs the scientific advisory board of SinusPharmacy Inc., the Santa Barbara, California, company that developed the new therapy. Stanford funded the study.

According to the researchers, most of the study patients would have had to take intravenous antibiotics had they not been given inhaled ones. They say that inhaled antibiotics could be offered to patients after trying other options, including oral antibiotics and surgery, and could possibly be used prior to IV drugs.

While "the results obtained so far have been very encouraging," Vaughan's team writes, larger studies are still needed.

Source: Otolaryngology, Head and Neck Surgery 2002;127:558-5568.

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New Weapon Against Prostate Cancer

HealthScoutNews

Wednesday, January 8, 2003

WEDNESDAY, Jan. 8 (HealthScoutNews) -- Combining vitamin D with the chemotherapy drug Taxotere seems to help men with advanced prostate cancer (news - web sites). That good news comes from a study in the January issue of the Journal of Clinical Oncology.

Results from a phase II clinical trial indicate that a combination of Taxotere and calcitriol is twice as effective as treatment with Taxotere alone, as measured by prostate-specific antigen (PSA) response rate.

The study included 37 men treated with the combination regimen. The study found that 81 percent of the men cut their PSA levels by more than half, and 59 percent of them had a PSA reduction of more than 75 percent.

PSA is produced in the prostate gland. A high level of PSA may indicate the presence of cancer. In men with advanced prostate cancer, the PSA level provides information about the amount of cancer in the body.

A phase III trial of the combination treatment is underway at 15 sites in the United States.

More information

The U.S. National Cancer Institute (news - web sites) has more about prostate cancer.

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Group: FDA Cannot Ensure Safety of Biotech Foods

By Randy Fabi

Reuters

Wednesday, January 8, 2003

WASHINGTON (Reuters) - The Food and Drug Administration (news - web sites) cannot guarantee the safety of genetically modified foods because it is unable to obtain all scientific data from biotech companies, a consumer group said on Tuesday.

The Center for Science in the Public Interest said companies like Monsanto Co., Syngenta AG and Dow Chemical Co.'s Dow AgroSciences all declined to provide requested scientific data to the FDA about strains of genetically engineered insect-resistant corn.

US biotech companies are encouraged, but not required, to submit food safety testing data to federal regulators for review. When the FDA requested additional information, biotech companies complied only half the time, according to an analysis of FDA data by the advocacy group.

"With a legally mandated approval process, the FDA can only review whatever data that a company lets it review," said Doug Gurian-Sherman, the group's science director and author of the report.

The Center for Science in the Public Interest, which supports biotech crops, said gene-spliced foods currently being marketed appeared to be safe for consumers. However, it said the FDA was "ill-equipped" to assure the safety of more complex biotech foods in the future.

FDA officials were not immediately available for comment.

Biotech Industry Disagrees

The Biotechnology Industry Organization, which represents companies such as Monsanto, Syngenta and Dow Chemical, said its members submit all necessary scientific data requested by the FDA.

Lisa Dry, the trade group's spokeswoman, said if certain information was not given, the FDA has the power to not allow the marketing of a biotech product.

"The FDA has all the authority necessary to collect information from manufacturers and to ensure consumers the food supply is safe," she said.

The industry does support some changes in the regulatory system to ease consumer concerns, including requiring companies submit more detailed testing information.

The United States is the world's largest producer of crops that are genetically modified to make them resistant to pests, or to withstand herbicides used to kill nearby weeds.

Some US trading partners, especially from Europe and southern Africa, have imposed strict rules on genetically modified crops due to concerns that they may be toxic and cause allergies. The United States strongly disputes these claims.

The FDA's stamp of approval on biotech foods are key to consumer acceptance, both advocates and critics say.

The report also found gaps in the scientific data provided to the FDA by biotech companies.

"We found that biotech companies weren't always performing the right tests to look for potentially dangerous compounds, including allergens," Gurian-Sherman said.

The center's concerns were presented on Tuesday before a panel of the National Academy of Sciences (news - web sites), which is studying the unintended health effects of biotech foods. The panel's conclusions will be presented to the FDA and the US Agriculture Department (news - web sites).

The Center for Science in the Public Interest recommended the FDA require biotech companies submit more detailed testing information and obtain federal approval before marketing their product.

Sen. Dick Durbin, an Illinois Democrat, is expected to introduce legislation later this year that would give the FDA this authority, the consumer group said.

Concerns about biotech foods grabbed headlines two years ago when banned StarLink corn was found to have entered the US food chain, sparking massive recalls of hundreds of corn products from grocery store shelves across the country.

Last month, the variety was found in a US corn shipment bound for Japan's food supply.

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Head-On Collusions

HealthScoutNews

Wednesday, January 8, 2003

(HealthScoutNews) -- It seems there's a great gender difference in the posture, proximity and position of two people approaching each other.

Women prefer the direct approach. Friendly men, on the other hand, prefer to approach another person from the side to demonstrate they're not being hostile, says author David Bodanis in his book, The Secret Family.

And two males "will never stand in direct proximity if they can avoid it. Instead they take up a strangely distanced now-don't-take-offense posture, with their chests not facing each other's directly," writes Bodanis.

Women want to "be cleanly approached from the front so they can see the other person," and a man who makes a sideways approach "is likely to be viewed with suspicion," he says.

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Hospitalized Kids' Spiritual Needs Not Met: Survey

By Amy Norton

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - The spiritual concerns of seriously ill children and their parents are only being partially met in hospitals, according to a US survey of specialists in such "pastoral care."

The survey of pastoral care providers at children's hospitals nationwide found that respondents felt their centers offered only a portion of what was needed for "ideal spiritual care" of patients and parents.

"We can do better," study author Dr. Chris Feudtner of Children's Hospital of Philadelphia in Pennsylvania, told Reuters Health.

Feudtner said that there has been growing awareness of how important spirituality is to adults who are coping with illness. Much less is known about the spiritual needs and care of sick children.

But even though spirituality and how it is dealt with in healthcare might seem complex, Feudtner said it is important to realize "this can be studied" and that "benchmarks" for quality spiritual care can be set.

His team's findings are published in the January online edition of the journal Pediatrics.

According to survey respondents, half of the patients they cared for were either infants who had been ill their entire lives or older children with chronic illnesses. About 20% were dying.

Care providers estimated that at least half of these children were feeling fearful or anxious, or needed help coping with pain and other symptoms or in dealing with their parents. They also estimated that most parents felt fearful or anxious, had difficulty coping with their child's pain or felt guilty.

But overall, providers felt their hospitals were only partially addressing such concerns.

One of the biggest problems is inadequate staff, according to the survey. Pastoral care offices vary widely among US children's hospitals, Feudtner explained. One hospital may have a chaplain plus a staff dedicated to spiritual care, while another may rely on only volunteers.

Survey respondents also said they are often called upon "too late" to provide all the spiritual care that a family might need. This could be due to a lack of staff, Feudtner said, or to doctors' and nurses' lack of training in how to tell when children and their families need spiritual help.

According to survey respondents, some of the best ways of meeting patients' spiritual needs are to simply listen to them, touch them or pray with them.

Source: Pediatrics 2003;111:e67-e72.

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Fevered Signs

HealthScoutNews

Wednesday, January 8, 2003

(HealthScoutNews) -- If your child has a fever, do you know what to do?

According to researchers at Schneider Children's Medical Center in Israel, many parents don't. The researchers surveyed 650 parents who were first asked where they learned about treating fevers. About 40 percent of respondents had asked a physician or nurse; 30 percent read package labels and the remaining 30 percent had asked their mothers what to do.

Asked specifically about the proper dosage of medication, 43 percent of the parents administered the right amount, but 24 percent used too little and 33 percent used too much. Eleven percent of parents were giving their children overdoses that could have been harmful.

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Cholesterol Drugs Less Effective Outside of Trials

Reuters Health

Wednesday, January 8, 2003

NEW YORK (Reuters Health) - Although many studies have shown that cholesterol-lowering statin drugs are effective, the benefits may not be as dramatic in the real world (news - Y! TV), new research suggests.

Investigators believe that, outside the controlled setting of a clinical trial, people are not as likely to stick with their statin regimen.

Their study of nearly 400 new statin users found that while participants had a drop in "bad" LDL cholesterol after several months, the reduction was one third less than would be expected based on clinical trials. The findings were similar for all three statin drugs studied--atorvastatin (Lipitor (news - web sites)), simvastatin (Zocor) and pravastatin (Pravachol).

"We believe this gap reflects the reduced patient compliance frequently observed in clinical practice settings," the researchers report in the December issue of the American Journal of Medicine.

According to Dr. Joseph P. Frolkis and his colleagues at the Cleveland Clinic Foundation in Ohio, the fact that LDL reductions were below expectations for all three drugs suggests that the reason rests with patients' adherence to the medications and, possibly, to diet.

In addition, there was wide variation in how different patients responded to statin therapy. This division between "poor responders" and "outstanding responders" does suggest that low compliance with treatment is the "most likely" reason for the smaller-than-expected cuts in LDL, according to an accompanying editorial.

In clinical trials of the three statins, few people had poor responses, notes Dr. Frank M. Sacks of Harvard University in Boston, Massachusetts.

Because statin therapy has been shown to cut both LDL and the risk of heart attack, it is important to figure out why patients might not comply with their prescriptions, according to Sacks.

Some people, he notes, may intentionally take a lower dose to save money, while others may worry about the drugs' safety.

"Physicians," he writes, "should emphasize to patients the benefits of taking their prescribed statin, and reassure them about safety."

Statins are regarded as generally safe, although side effect worries were fueled by the recent recall of Baycol (cerivastatin), a statin that was associated with severe muscle weakness, and several deaths from rhabdomyolysis, in which the muscle breaks down.

The American College of Cardiology, the American Heart Association (news - web sites), and the National Heart, Lung and Blood Institute recently issued clinical guidelines that say that despite the problems with Baycol, statins are safe and remain one of the best weapons against high cholesterol.

Source: American Journal of Medicine 2002;113:625-629.

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TUESDAY, JANUARY 7, 2003 

Chew on This 

HealthScoutNews

Tuesday, January 7, 2003

(HealthScoutNews) -- If you chew an old piece of gum, you know how your jaw almost hurts.

But did you also know it can impact your heart and blood pressure?

The department of orthodontics at the University of Naples in Italy published a study, in the Archives of Oral Biology, that proved old gum should probably be tossed away.

The study found that when 10 healthy volunteers chewed on pieces of very hard gum at the rate of 80 chews a minute, their heart rate increased by 11 beats per minute, and their blood pressure went up by 14 millimeters of mercury.

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Multiple Births Up, but Survival Higher Too: Report 

By Charnicia E. Huggins

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Multiple births in the US jumped nearly 60% between 1980 and 1999, with a more than 110% increase among women aged 40 to 44, according to a new report.

"The study highlights the increasing rates of multiple births in the United States, but shows that the increases are not occurring uniformly across all segments of the population," Rebecca Russell, a research analyst at the March of Dimes Perinatal Data Center in White Plains, New York, told Reuters Health.

Overall, the number of higher order births--triplets and greater--increased almost 423% from 1980 to 1998, from 37 to 193.5 births per 100,000 live births, the report indicates. The findings are based on an analysis of 1980-1999 data from the National Center for Health Statistics.

"Because multiple births are more likely to be low birthweight or preterm, it is important for health care providers to recognize the impact of multiple births on these outcomes and to be aware of how the profile of multiple births is changing," Russell said.

The increase in multiple births was largely accounted for by births to white mothers, who experienced a 25% greater increase in twin births in comparison to their black peers, even though black women remained more likely to have twins, the report indicates. White mothers, however, were more likely to have triplets and other higher order births, the researchers report in the January issue of Obstetrics and Gynecology.

The reason for the increased multiple births among white mothers is most likely due to their increased use of assisted reproductive technologies and other types of fertility treatments, the researchers note.

Increased use of fertility treatment may also explain the overall increase in multiple births across the United States, but since there is little or no "nationally representative data on mode of conception," researchers cannot be sure that that is the reason, according to Russell.

Although multiple births increased in every age group, the greatest increases were observed among older mothers, particularly those aged 40 to 44, study findings show. Women in the Northeast were also more likely to have multiple births than women in the Midwest, South and West, "which can be correlated with the increase in infertility services and clinics, specifically in the Northeast," Russell said.

Finally, along with this increase in multiple births, there was a more than 26% drop in the infant death rate overall between 1989 and 1999, from 9.5 to 7 per every 1,000 live births.

Multiple birth infants are known to have a greater risk of death than single infants, yet the findings show that the infant death rate dropped more than 30% among this at-risk group in comparison to 28% among their single-born peers. Still, death rates remained five times higher among multiple birth infants than among single babies in both 1989 and 1999.

The overall decline in infant deaths was "due in part to advances in maternal, fetal and neonatal management, including advances in medical technologies," Russell said. "This progress has continued to improve survival for high risk babies born early and small."

"People should be optimistic." Russell added. "This study underscores the fact that we are continuing to make progress to improve perinatal outcomes.

"Any reduction in infant mortality is good for all expectant mothers, whether the pregnancy is singleton or multiple," Russell said. "However, we need to encourage all women to go in for care as soon as they think they are pregnant and we also need to encourage women to come in for preconception care."

Source: Obstetrics and Gynecology 2003;100.

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Viagra Doesn't Dim Vision

HealthScoutNews

Tuesday, January 7, 2003  

TUESDAY, Jan. 7 (HealthScoutNews) -- Viagra does not reduce blood flow to your eyes.

So says a University of California-Irvine study that appears in the January issue of Opthalmologica.

Because the impotence drug lowers overall blood pressure, there were concerns it might cause decreased blood flow to the eyes, and thereby cause nerve damage and vision problems.

However, this study found that even high doses of Viagra, used to treat erectile dysfunction, do not reduce blood flow to your eyes.

The study included 13 men at Stanford University. Overall, the researchers found Viagra had little effect on the thickness of the eye's choriods layer, which supplies the eyeball with blood.

The study did find some minor variations in the thickness of the eye's choroids layer as the result of taking Viagra. The study says this indicates that some people with vascular diseases may experience vision changes when they take Viagra.

The study also concludes there was no connection between blood flow, choroid thickness and changes in color vision, which is a common side effect in people who take Viagra.

More information

The U.S. National Institutes of Health (news - web sites) has more about erectile dysfunction.

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Alzheimer's Drugs Relieve Several Symptoms 

By Merritt McKinney

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Drugs used to preserve memory and intelligence in people with mild to moderate Alzheimer's disease (news - web sites) may provide other benefits as well, according to a new report.

In a review of clinical trials, drugs called cholinesterase inhibitors seemed to improve psychiatric symptoms, such as hallucinations and paranoia, which often affect people with Alzheimer's. In addition, the drugs, which are the only medications approved in the US to treat the memory-robbing disease, also seemed to help people with Alzheimer's maintain their daily activities longer than people who did not take the medications.

The findings are published in the January 8th issue of the Journal of the American Medical Association (news - web sites).

"These drugs, which are underutilized in general, most likely because many docs question how helpful they are, may have another role" in the treatment of Alzheimer's disease, Dr. Kristine Yaffe, the study's lead author, told Reuters Health.

The report "may lead to changes in clinical practice as more docs may be likely to use the drugs," said Yaffe, who is at the University of California at San Francisco. Yaffe said she hopes physicians would prescribe cholinesterase inhibitors "before using psychiatric drugs that may have more side effects."

Memory loss is probably the best-known symptom of Alzheimer's, but as many as four out of five people with the disease will also experience psychiatric symptoms, such as hallucinations, paranoia and agitation. The disease also makes it harder and harder for people to carry out their daily activities, such as using the telephone, taking medications and feeding and dressing themselves.

Currently, cholinesterase inhibitors are the only drugs approved in the US for the treatment of Alzheimer's disease. These drugs have been shown to slow the loss of cognitive function, such as memory and intelligence, but Yaffe's team set out to see what effect, if any, the drugs have on other Alzheimer's symptoms.

In a review of 29 studies of cholinesterase inhibitors, the researchers found that cholinesterase inhibitors seem to provide modest benefits in terms of psychiatric symptoms and functional impairment in people with mild to moderate Alzheimer's disease. Each of several cholinesterase inhibitors provided similar benefits.

"The next step," Yaffe said, "would be to enroll patients with Alzheimer's disease and also all with behavior problems and see if these (drugs) help." Another question that needs to be answered, Yaffe said, is how the benefits of the drugs affect patients' quality of life, as well as whether the improvements provided by the drugs translate into benefits for caregivers.

Source: Journal of the American Medical Association 2003;289:210-216.

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Money Matters in the ER

HealthScoutNews
Tuesday, January 7, 2003 

TUESDAY, Jan. 7 (HealthScoutNews) -- Waiting times for patients are longer in financially strapped hospital emergency departments in poorer neighborhoods.

That's the claim of a study in the January issue of the Annals of Emergency Medicine.

Between Dec. 15, 2000, and May 15, 2001, researchers observed 1,798 randomly selected people in emergency departments in California hospitals. The people were monitored from their arrival at the emergency department to their first contact with a doctor, nurse practitioner or physician assistant.

The study found the average waiting time for most emergency department patients is 56 minutes. However, 42 percent of the people in the study had to wait more than an hour.

The study found the waiting times were longer in poorer neighborhoods. For every $10,000 decline in per capita income within a zip code area, emergency department patients had to wait 10 minutes longer. That was true in both public and private hospitals.

The researchers hypothesize that these poorer communities have more people with no health insurance and complex medical problems who need more financial, administrative and social support.

The study also found that waiting times were shorter in emergency departments that had a greater ratio of triage nurses and doctors to patients.

More information

The American College of Emergency Physicians (news - web sites) has more about emergency department waiting times.

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Obesity Cuts Lifespan by Up to 20 Years: Studies 

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Obesity is a well-known risk factor for heart disease, diabetes and other chronic diseases that can cause premature death. Now, two national studies reveal that obesity can, on average, cut more than a decade from a person's life. For black men it can shorten life by up to 20 years.

The findings support the notion that excess body weight is more than a cosmetic problem, and may spur individuals, doctors and public health officials to redouble efforts to keep weight in check.

"Excess weight has not received the same attention from clinicians and policymakers as have other threats to health such as tobacco use, hypertension, or (high cholesterol)," Drs. JoAnn E. Manson and Shari S. Bassuk from Brigham and Women's Hospital in Boston, Massachusetts, write in an accompanying editorial. "It is not surprising that obesity rates continue to climb."

According to both studies, obesity is particularly dangerous for younger adults, or those in their 20s and 30s. Severely obese white men aged 20 to 30 years live about 13 fewer years than they would be expected to based on estimates from national data. Severely obese white women, or those with a body mass index (BMI) over 45, can expect to live eight fewer years, report researchers in the January 8th issue of the Journal of the American Medical Association (news - web sites).

Obesity also had a profound effect on the lifespan of younger blacks. Obese black men aged 20 to 30 lose about 20 years and obese black women lose about 5 years of life, even after accounting for smoking.

BMI is a measure of weight in relation to height and is believed to be a more reliable gauge of disease risk than weight alone. A person with a BMI of 30 is considered obese, while a person with a BMI between 25 to 29 is considered overweight. To have a BMI of 45, a person who is 5-feet, 4-inches tall would weigh 262 pounds.

In the study, white adults with a BMI of 23 to 25 and black adults with a BMI of 23 to 30 lived the longest.

"Obesity has a profound effect on life span," Dr. David B. Allison from the University of Alabama in Birmingham, and colleagues conclude.

The findings are supported by a second report on more than 3,000 people aged 30 to 49. According to this study, obese, non-smoking women lived seven fewer years and obese, non-smoking men lived about six fewer years than their normal-weight peers did.

Among smokers, obesity reduced life expectancy by about seven years. And obese female smokers lived 13 fewer years and obese male smokers nearly 14 fewer years than non-smoking adults of healthy weight, according to the study.

Together, these reports quantify the health risks associated with obesity, especially for young and middle-aged adults. Considering that about two thirds of the US adult population is overweight or obese, the findings portend an ongoing health crisis, warn researchers.

"The results point to a troubling trend, as rates of overweight and obesity continue on an upward slope in the US," write Dr. Anna Peeters from Erasmus MC in Rotterdam, the Netherlands, and colleagues. "The smoking epidemic in the western world is waning; however, a new fear should be the increasing prevalence of overweight and obesity in young adults, which heralds another potentially preventable public health disaster."

Their study is published in the January 7th issue of the Annals of Internal Medicine.

The authors of both reports call for more research, particularly into the apparent differences in the relationship between obesity and life span between whites and blacks.

Nonetheless, the findings "confirm that obesity is a major public health problem that appears to lessen life expectancy markedly, especially among individuals in younger age groups," Allison and colleagues conclude.

In many cases, obesity and its associated diseases such as type 2 diabetes and high blood pressure may be preventable. The US Centers for Disease Control and Prevention (news - web sites) recommends that people trying to maintain good health schedule 30 minutes of moderate physical activity each day, and 60 minutes each day for weight loss.

Source: Journal of the American Medical Association 2003;289:187-193, 229-230;

 Annals of Internal Medicine 2003;138;24-32.


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Hormone Therapy a Matter of Doctor Specialty

 

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 7, 2003

TUESDAY, Jan. 7 (HealthScoutNews) -- Whether doctors continue to recommend hormone replacement therapy may have more to do with what they learned back in medical school than what they read in medical journals today.

At least that's the word from a new study in the January issue of Obstetrics and Gynecology.

Researchers report that physicians who specialize in gynecology are nearly three times more likely to prescribe hormone replacement therapy (HRT) than family practitioners -- even when they see the same number of menopausal patients.

"When we compared the two groups we found that family practice doctors were prescribing HRT less frequently than gynecologists, perhaps because they were less certain of the benefits of HRT," says study author Dr. Barcey Levy, an associate professor of family medicine at the University of Iowa School of Medicine.

This time last year the hesitancy of family doctors to prescribe HRT might have been interpreted as a deficit in women's health care. However, in light of the recent findings by the Women's Health Initiative -- studies that seriously question the benefits of HRT -- the balance of power has clearly shifted, landing smack in the lap of the family doctor.

"Our study was conducted and ultimately completed long before the current news on HRT was known, but certainly family doctors may have been prescribing HRT less often because they were intuitively less confidant about the use of these drugs," Levy says.

That is something the statistical information in the study seems to support: The women who saw family doctors were far more likely to cite uncertainty about the safety of HRT as their reason for not taking hormones. And it's a conclusion that Levy admits may have been influenced by their doctors.

For gynecologist Dr. Isaac Schiff, however, the data may represent a slightly different finding.

"Generally speaking, gynecologists are usually more familiar with these drugs. So ultimately they are likely to be more comfortable prescribing them -- which is one reason why women may be more comfortable taking the drug from them," says Schiff, chief of the Vincent Memorial Obstetrics and Gynecology Service at Massachusetts General Hospital and a spokesman for the American College of Obstetricians and Gynecologists.

However, Schiff says, it's also important to note that women themselves play an important role in the decision whether or not to take HRT.

"Women who actively seek out a gynecologist for their annual exam may be women who are experiencing more troubling menopausal symptoms and they may also be women who are more open to the idea of taking hormones, and both factors can influence how often these medications are prescribed," he says.

The new study involved a small group of 426 postmenopausal women, all of whom attended one of two clinics run by the University of Iowa School of Medicine. Roughly half the women attend the gynecology clinic for their annual exam, while the other half received their annual physical at the family practice clinic.

Overall, 60 percent of the women attending the family clinic and 69 percent attending the gynecology clinic were already users of HRT.

However, after examining the medical records as well as patient questionnaire data on all 426 women, the doctors found the difference in prescribing habits.

"Although the number of women using HRT in both groups was higher than that of the national average, in the final analysis we found the women who were seeing the gynecologists, as compared to those seeing the family doctors, were 2.6 percent more likely to be on HRT," Levy says.

An interesting sidebar to the study -- and one worthy of further research, Levy says -- was that women who reported a history of depression were nearly three times more likely to be using HRT, regardless of which doctor they saw.

"Perhaps these women were experiencing more severe symptoms, or they may have been in closer contact with their health-care provider, or perhaps the chemistry of depression itself is in some way linked to menopausal symptoms. We just don't know, and won't know until further research is conducted in this area," Levy says.

What To Do

To learn the very latest on the safety and effectiveness of hormone therapy, visit the Women's Health Initiative.

To learn more about family practice medicine, visit The American Academy of Family Physicians.

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C-Section Lowers Herpes Risk for Newborns 

By Merritt McKinney

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - New research may make it easier to keep newborns from being infected with the herpesvirus, which can cause brain damage and even death.

In a new study, researchers found that the longtime practice of performing a cesarean section in women who have active herpes infections does indeed reduce the risk that their newborns will be infected with the virus. The study also found that women who had been infected with herpes relatively recently were more likely to pass on the virus to their babies than women who had been infected for a longer time.

The "bottom line" of the research, lead investigator Dr. Zane A. Brown told Reuters Health, "is that we have to prevent women from acquiring genital herpes during pregnancy to prevent the newborn from acquiring neonatal herpes."

To do this, doctors should use a blood test to screen pregnant women for genital herpes the first time they seek prenatal care, according to Brown, who is at the University of Washington in Seattle.

"If they are found to be susceptible, then we must test their partners," Brown said. If there is a chance that a woman can be infected by her partner, then doctors should advise the woman on how to protect herself, according to the Seattle researcher. This may include abstaining from sex during pregnancy, using condoms or having her partner use an antiviral drug such as acyclovir, Brown said.

Though symptoms of herpes, particularly genital herpes, can be extremely painful, infection with the herpes simplex virus, or HSV, is generally not life-threatening in adults. When a child becomes infected with HSV, often after being exposed to genital secretions during delivery, the infection can be deadly if it is not treated. HSV infection may cause brain damage in children who survive.

One type of herpesvirus, HSV-1, usually infects the mouth and causes cold sores on the mouth and face. Another type, HSV-2, most often causes sores on and around the genitals.

Both HSV-1 and HSV-2 may be present in the birth canal, so infection with either type may put newborns at risk.

For women who have herpes sores on their genitals during pregnancy, a C-section is usually recommended to reduce the risk of transmission during birth. There is little evidence on whether this practice reduces infant herpes infections, however.

Now, Brown and his colleagues report that cesarean delivery can indeed reduce a woman's risk of passing on HSV to her child.

In a study of 202 pregnant women who were infected with HSV at the time of delivery, only about 1% of women who had a C-section gave birth to a child with HSV, compared with nearly 8% who delivered vaginally.

A report on the study appears in the January 8th issue of the Journal of the American Medical Association (news - web sites).

Brown's team identified several other factors that affected the transmission of HSV. Women who had been recently infected, meaning their bodies had not had enough time to produce antibodies to HSV in the blood, were most likely to pass on the infection during birth. This risk, according to the report, reflects the fact that these women's infants lacked antibodies of their own to ward off HSV.

The study also found that women who had been previously infected with HSV-2 had a very low or nonexistent risk of passing on either HSV-1 or HSV-2 during birth.

A woman's care during labor also seemed to have a large impact on the risk of spreading HSV, according to the report. Infants whose mothers had undergone invasive monitoring tests as they prepared to give birth were more likely to be born with HSV.

Source: Journal of the American Medical Association 2003;289:203-209.

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Heart-Filling Problem Prevalent and Deadly

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 7, 2003 

TUESDAY, Jan. 7 (HealthScoutNews) -- One-fourth of American adults over age 45 have a condition related to heart failure that greatly increases their chances of dying prematurely -- even if they don't yet have heart failure.

Congestive heart failure, a condition that affects more than 3 million Americans, can involve problems in the heart's pumping ability as well as its ability to relax and fill with blood between beats. The latter aspect, called diastolic functioning, has been understudied, some experts say.

But a Mayo Clinic survey of 2,042 residents of Olmsted County in Minnesota suggests that abnormal diastolic functioning may be more dangerous than previously thought. In the survey, more than one in four adults older than 45 were found to have these abnormalities in diastolic functioning that can boost their death risk. And they were eight times more likely to die within the five-year follow-up than those who had normal functioning.

"If you have a problem with diastolic functioning, even if you don't have [diagnosed] heart failure at that time, that abnormality was associated [in the study] with increased mortality from all causes," explains Dr. Margaret Redfield, director of the Mayo Clinic Heart Failure Clinic and lead author of the study, appearing in tomorrow's Journal of the American Medical Association (news - web sites).

Redfield hopes the study will raise awareness among other cardiologists, internists and family physicians as well as consumers about the causes of heart failure. Problems not only with heart-pumping function but also the heart's ability to relax and fill with blood can increase the risk of heart failure and death, she says.

To consumers, she adds, "Be aware that heart failure can be caused by a normally squeezing but stiff heart." In other words, your heart is pumping properly but not properly filling with blood between beats.

Symptoms of heart failure include shortness of breath, easy tiring, fatigue, and swelling of the feet, ankles and legs as fluid accumulates. Several drugs treat the condition.

"We knew diastolic problems could cause heart failure," Redfield says. "But we were somewhat surprised by how potent a predictor of mortality the presence of diastolic dysfunction was."

More than a fourth of those studied had diastolic abnormalities and often had not been diagnosed yet with heart failure.

Redfield says she is hopeful the study result will encourage more consistent measurements of the diastolic functioning of the heart, which are done through an echocardiogram, a recoding of sound waves bounced off the heart to produce images of it.

She also hopes that general-practice physicians and internists will become more aware of the potential problems those with diastolic dysfunction could have.

The study is "very important," says Dr. Zi-Jian Xu, a cardiologist at the UCLA-Santa Monica Cardiology Group in California, "because the problem is very prevalent."

"Physicians for years have observed the phenomenon [of diastolic problems]," he says. "But not one has put numbers to it. It's been known that diastolic dysfunction is one of the causes of morbidity [disease], and now it's linked to mortality."

To consumers, Redfield gives this advice: "If you have symptoms [of heart failure] and your doctor says your heart is squeezing just fine, your next question should be, 'Is its relaxing-and-filling function normal?'"

What To Do

For more information on congestive heart failure, try the American Heart Association

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Use Maggots to Clean Wounds, Prevent Amputation 

By Alison McCook

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Despite the benefits of modern medical technology, new evidence suggests that doctors should sometimes cede to the authority of the earth's original healer, Mother Nature.

A new study describes the benefits of using maggots to treat stubborn wounds that refuse to heal as a result of infection or other problems. Maggots digest dead tissue and destroy bacteria.

Often these wounds, which can result from serious trauma or medical problems such as diabetes, leave doctors no choice but to amputate part or all of a limb.

Although the researchers did not compare patients treated with maggots to those with similar wounds treated with a different technique, they found that placing maggots on a traumatic wound helped clean the area and, in some cases, prevented amputation.

Study author Dr. G.N. Jukema at Leiden University Medical Center in the Netherlands told Reuters Health that although the idea of maggots to clean wounds may be less than appealing to some, patients are willing to try it. "All patients we have treated were very enthusiastic because of the good clinical results," Jukema said.

Jukema added that maggots represent the "last option," and generally cannot replace surgical cleaning of the wound or antibiotics when preventing amputation.

When maggots are placed on an open wound, they secrete proteins that break down dead tissue fragments, creating a soup that the maggots ingest. Maggots also release substances that help protect the injured skin from becoming re-infected, and their crawling on the wound may also encourage the growth of new tissue.

When treating the injured patients, Jukema and colleagues placed at least 100 so-called "sterile" maggots on the wounds of three patients, then covered the wound surface with a light net dressing. After a few days, patients began to report feeling pain from the biting and crawling of the maggots, so the researchers gave them anesthesia.

As an alternative, Jukema and colleagues treated other wounds using maggots that had been captured inside porous material the size of a tea bag. These maggots still secrete substances and absorb materials through the bag, but spare patients the pain of biting and crawling.

In a recent issue of Clinical Infectious Diseases, Jukema and colleagues describe their experiences using maggots to treat 11 patients with stubborn wounds. Nine patients recovered fully, they note, and the other two died of other causes.

In one instance, the researchers treated a 16-year-old who developed wounds in his hands and feet as a result of bacterial infection. Doctors amputated his right foot and sections of his fingers and gave him an IV of antibiotics, then placed 20 bags filled with 750 sterile maggots on his wounds. The patient improved steadily, Jukema and colleagues report, and all wounds healed by 5 months.

In another instance, doctors used maggots to prevent amputation in a 54-year-old man with an infected leg wound that wouldn't heal. After placing maggots on the wound, the signs of infection began to dissipate, and the patient left the hospital five weeks later--all without the help of antibiotics.

Speaking with Reuters Health, Jukema noted that maggots used in surgery are sterilized. Maggots are larvae, Jukema explained, and their eggs are sterilized before they hatch.

The researcher added that maggots could also be used to treat burns.

Source: Clinical Infectious Diseases 2002;35:1566-1571.

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Aging Population Boosts Influenza Deaths in US 

By Alison McCook

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - More people died of influenza during recent years than 20 years ago, largely because the US population is aging and older people tend to be at greatest risk from the flu, according to new study findings.

These results affirm the need for targeting influenza vaccine to the elderly, and suggest that more effective vaccines that specifically prevent flu in the elderly are needed, according to Dr. William W. Thompson and his colleagues at the US Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta, Georgia.

The seriousness of the influenza virus is often underestimated, noted study co-author Dr. Keiji Fukuda, and these findings demonstrate that people need to be serious about protecting themselves.

Influenza and a virus with similar effects, respiratory syncytial virus (RSV), "are really major causes of death and illness in the United States," Fukuda said.

Both influenza and RSV produce similar symptoms, Fukuda told Reuters Health, so the average person would not know which virus is responsible for his or her fever and achy body.

In many cases, the danger of these viruses is not the infections they cause, but the underlying illnesses that can be aggravated by those infections, Fukuda added.

Most otherwise healthy people who become infected with influenza or RSV eventually recover, Fukuda said. However, people with heart and lung diseases, and those with weakened immune systems, can develop pneumonia or serious complications such as respiratory attacks or heart failure due to their underlying conditions.

Although researchers have estimated the death rates due to influenza and RSV, Fukuda explained that the current method is likely more accurate, for it is the first to include so-called viral surveillance data, which tracks how many people are infected with each virus throughout the year.

The researchers report their findings in the January 8th issue of the Journal of the American Medical Association (news - web sites).

Fukuda, Thompson and their colleagues discovered that the number of deaths due to influenza increased between 1976 and 1999. Most of the people who died from heart and lung causes linked to influenza and RSV were above age 65, the authors note, and influenza was likely responsible for three times as many deaths as RSV.

Currently, the researchers estimate that in particularly bad years, as many as 50,000 to 70,000 people die from influenza in the US.

Since so many deaths linked to these infections occurred in the elderly, the authors reasoned that the increase in influenza and RSV-related deaths is likely due, in part, to the concurrent increase in the proportion of the population that is over age 65.

In addition, the authors note that the strains of influenza circulating during the most recent years were more virulent than in the past, which might also help explain the higher death rates.

Fukuda noted in an interview that after November, doctors and patients alike often stop thinking about influenza vaccines. He encouraged doctors to keep offering the vaccine through the winter months, "as long as vaccine is available and there are high-risk patients who haven't been vaccinated," such as those over 65 or younger people with underlying risky conditions.

The current findings also highlight the need for an effective RSV vaccine, Fukuda added, which he said is currently under investigation.

Until new and more effective vaccines for influenza and RSV become available, Dr. David M. Morens of the National Institutes of Health (news - web sites) in Bethesda, Maryland, who authored an accompanying editorial, suggests that doctors help protect patients by vaccinating themselves.

This step will prevent doctors from giving the virus to their patients and reduce sick days, he notes, and also "sets a powerful example."

"The article by Thompson (and his colleagues) presents a fresh look at influenza mortality," Morens writes. "Now may be the time to take a fresh look at what can be done about it."

Source: Journal of the American Medical Association 2003;289:179-186,227-228.

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Norwalk Virus: Outbreaks on Land, Sea 

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 7, 2003

TUESDAY, Jan. 7 (HealthScoutNews) -- Major outbreaks of Norwalk-like virus that have infected 700 people in Boston provide the latest evidence that the nasty stomach bug that sickened so many cruise ship passengers is hardly limited to the high seas.

In fact, experts say, the gastrointestinal illness is much more prevalent on land.

The 17 Boston outbreaks struck nursing homes, rehabilitation centers, homeless shelters and hospitals during the past six weeks. Local health authorities call the outbreaks the worst in almost two decades since the viruses were identified. Symptoms include diarrhea, vomiting, stomach pain and headaches for up to two days.

Experts say the outbreaks reflect an upsurge in the number of cases of Norwalk-like viruses, which are named after an outbreak in Norwalk, Ohio, in 1968.

Federal health officials blame the same viruses, the leading cause of gastrointestinal illness, for nine outbreaks aboard cruise ships within the past six months.

The cruise ship stomach bugs gave new meaning to "seasick," creating memories vacationers would just as soon forget, and drew international headlines that suddenly made Norwalk-like viruses a familiar term.

But the cruise ship viruses represent but a tiny fraction of at least 23 million Norwalk-like illnesses in the United States each year, federal health officials say. They add that the number could be much greater because many cases likely go unreported.

"There's little doubt that what's going on in cruise ships is a reflection of what's happening on land," says Dr. Marc-Alain Widdowson, a Norwalk virus specialist at the U.S. Centers for Disease Control and Prevention (news - web sites). "There's no reason to think there's any greater risk on a cruise ship than any other place with people in close proximity."

Outbreaks at sea and on land show just how quickly and easily the viruses spread, especially when lots of people are packed into confined areas.

Norwalk-like viruses most often spread through tiny amounts of fecal matter when people don't wash their hands after using the bathroom, Widdowson says. Extremely contagious, the viruses can be transmitted through a handshake or other physical contact, on surfaces or through contaminated food or water. Even breathing tiny particles from vomit can spread the viruses through the air, he says.

Recovery normally comes by the third day without treatment, and hospitalization is rare. But those with heart disease, diabetes or other conditions that make loss of fluids particularly risky should seek medical care, health experts say.

Simple steps like regular, thorough handwashing and avoiding physical contact with infected people could go a long way toward preventing the spread of the viruses, experts say.

Dr. Anita Barry, director of communicable disease control at the Boston Public (news - Y! TV) Health Commission, says her city's outbreaks "certainly demonstrate that it's not hard to spread these types of viruses and also demonstrate there's a lot of room for improvement in hygiene."

She and other public health officials hope that message takes hold at a time when widespread anecdotal evidence suggests significant increases in the number of outbreaks.

In Minnesota, for instance, health officials reported an "unprecedented" 25 separate Norwalk-like outbreaks, sickening as many as 1,000 people in November and December, at sites including restaurants, schools, hospitals and nursing homes. And in Canada, officials in Edmonton and central Alberta report the worst outbreaks in 20 years, afflicting more than 1,000 people.

Health experts also urge cruise ship passengers to wash hands regularly and avoid contact with infected people. And the CDC's Widdowson says disinfectants like bleach and chlorine gas are effective at destroying Norwalk-like viruses aboard ships.

But, he says, cleaning efforts are complicated because the viruses are tough to detect on surfaces.

Just how tough became evident after Disney Cruise Line thoroughly scrubbed down its 2,600-passenger Magic cruise ship, only to have stomach illnesses recur on the next cruise aboard the same ship.

Still, there's no epidemic at sea, and the odds of picking up a bug are slim, considering that 7 million people were estimated to have boarded cruise ships in North American last year, industry officials say.

Mark Jaronski, a Disney Cruise Line spokesman, says the company worked closely with the CDC and heeded advice to develop more-thorough sanitization.

Jaronski says the coverage of shipboard illnesses has had no effect on bookings. "It got to somewhat hysterical levels, but I think if you put it in perspective, many of the obvious questions are answered pretty easily," he says. "People are experiencing these symptoms across the country and globe. There's nothing unique to the ships."

The CDC attributes more of the recent gastrointestinal illness on ships to Norwalk-like viruses than to any other cause. Of 21 outbreaks in the past six months -- defined as gastrointestinal illness among at least 3 percent of the people on a ship -- nine resulted from Norwalk-like viruses. Bacteria caused three other outbreaks, and the cause of nine others remains unknown, the CDC says.

What To Do

For more on Norwalk-like viruses, visit the Virginia Department of Health. For more on cruise ship sanitation, see this CDC site.

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US States Getting 'F' for Tobacco Control Efforts 

By Charnicia E. Huggins

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Many US states and the District of Columbia are not making the grade when it comes to creating laws to discourage smoking and properly using funds that should be targeted toward tobacco cessation and education programs, according to a report released Tuesday.

The funds are from a $206 billion settlement reached between the tobacco industry and 46 states in November 1998 to recover money spent by the states for tobacco-related health care costs. Four additional states settled their tobacco lawsuits for $40 billion.

Unfortunately, much of these funds are no longer being used for their original purpose, and are instead being used as general funds in various states "to plug holes in the budget," John L. Kirkwood, president of the American Lung Association, told Reuters Health.

"That's a mistake," according to Kirkwood. "It's short-sighted," he said, citing a need for state officials to look past the next election.

If you can reduce smoking now, you can reduce the long-term costs of smoking-related disease in the future, he added.

The current report, the first annual American Lung Association State of Tobacco Control 2002, is based on an analysis of various states' general tobacco control strategies in four areas: tobacco prevention and cessation program funding, smoke-free air laws, tobacco taxes and youth access laws.

Overall, 18 states received an "A" in at least one area, but only four states--California, Maine, New York and Rhode Island--received an "A" in two of the four areas, findings show. All four states excelled in their efforts to control youth access to tobacco products.

Arkansas, Indiana, Maine, Maryland, Minnesota and Mississippi earned an "A" for being the top six states in tobacco prevention spending. Yet five states--Massachusetts, Illinois, Nebraska, Iowa and California--cut their tobacco prevention program funding by 45% or more.

Four states, however, including California, Delaware, Vermont and Maryland, received an "A" or a "B" for their efforts to protect residents from the health dangers of secondhand smoke.

In fact, with the enactment of its Clean Indoor Air Act in 2002, Delaware joined California in establishing the most stringent--and protective--anti-smoking policies in the US. Delaware now prohibits smoking in restrooms, lobbies and other common-use areas as well as in most indoor public places. Forty-three states and the District of Columbia received an "F" for their efforts to pass smoke-free air laws.

What's more, 28 states, including Georgia, New Jersey, and Wisconsin, failed to create environments in which youth were severely restricted or prohibited from accessing tobacco products. Seven states--California, Connecticut, Maine, New York, Rhode Island, Texas and Vermont--excelled in this area, by placing tobacco products behind counters, performing random retail inspections, and implementing various other youth access laws. Arkansas and Idaho received a "B" for their efforts.

Finally, 29 states were given low marks for having inadequate state laws regarding cigarette taxes. Seventeen states received an "F," and 12 states received a "D." In contrast, 21 states scored average or above average marks, including seven states that earned an "A."

Those "A"-list states included Massachusetts, which implemented the highest increase in cigarette taxes, 0.75%, New Jersey, which implemented a 0.70% increase and Oregon, which implemented a 0.68% increase in cigarette taxes.

Altogether, however, the report's findings are "disappointing," Kirkwood said, particularly since previous surveys show the public to be largely in favor of increased taxes on cigarettes and smoke free environments.

In light of the findings, Kirkwood advises people to contact their elected officials and tell them to use their settlement funds for tobacco cessation and education programs.

And, he added, current smokers should quit and all parents should encourage their children not to smoke.

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Peruvian Plant Extract May Benefit Arthritis 

By Michael Leidig

Reuters Health

Tuesday, January 7, 2003

VIENNA (Reuters Health) - A Peruvian plant called Uncaria tomentosa, or Cat's claw, seems to be an effective treatment for rheumatoid arthritis, according to preliminary research conducted at Innsbruck University Hospital.

In rheumatoid arthritis, the immune system attacks the tissues that line the joints, leading to pain, inflammation and deformity. In a small study, the plant extract was found to modulate patients' immune systems, safely reducing the number of swollen and tender joints.

Dr. Erich Mur of the hospital's rheumatology outpatient department was this week awarded a prize from the Austrian Society of Phytotherapy for the study, which included 40 patients with active rheumatoid arthritis.

The patients were taking traditional medications, including sulfasalazine or hydroxychloroquine as well as corticosteroids and non-steroidal anti-inflammatory drugs.

In addition to this, they were given a standardised extract of Uncaria tomentosa.

The first phase of the study lasted 24 weeks. In the second phase, which lasted 28 weeks, all patients were given the plant extract. Patients were continuously examined to ascertain the number of their tender and swollen joints. Morning stiffness and pain were also monitored.

"The number of tender joints in patients, as well as morning stiffness were reduced in the first study phase," Mur told Reuters Health.

In a recent report in the Journal of Rheumatology the researchers said treatment with the extract reduced the number of painful joints by 53% compared to 24% for patients given an inactive placebo.

In the second phase, the number of swollen joints as well as the number of tender joints were also found to be reduced in patients.

"The reduction in swollen joints occurred, however, only in the second phase," Mur said.

The Peruvian plant is known to reduce the activity of several components of the immune system, Mur said.

"One advantage of using the plant is that there were no or only minor side effects," Mur said.

He said that the plant extract can be used effectively as an additional element in standard treatment.

Source: Journal of Rheumatology 2002;29:678-681.

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Response to AIDS Drugs Equal Across Race: Study 

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Powerful AIDS (news - web sites) drug combinations known as highly-active antiretroviral therapy (HAART) are equally effective in patients regardless of race or ethnicity, report researchers.

The results contradict those of previous studies showing that these and other factors, such as age and income, may influence how well a person responds to HAART.

But according to the current report, language barriers, different health beliefs, the stigmatization of HIV (news - web sites)-infected individuals and other factors may affect the use of medication.

To investigate, researchers reviewed data on 389 whites and 135 non-whites older than 15 living in Denmark, which has a national health care system. One year after receiving a prescription for HAART, there were no differences in the viral load, or levels of HIV in the blood, between the two groups of patients, report researchers in the December 15 issue of Clinical Infectious Diseases.

"Race and ethnic origin play no major role in the outcome associated with HAART if access to health care is free," conclude Dr. Soren Jensen-Fangel and colleagues from Aarhus University in Denmark.

They explain that US studies showing that a person's racial or ethnic background affects the response to treatment are probably not accounting for economic status.

"Non-white background will be closely linked to relatively poorer access to health care" in the US and similar countries without a national health care system, Jensen-Fangel and colleagues explain. "Access to health care and antiretroviral treatment is free in Denmark--that is, the outcome is not affected by the financial status of the patient per se."

The study also found that nonwhite patients were more likely to delay initiation of their treatment, for reasons that are not clear.

"An increasing number of patients with HIV infection in Denmark will be of nonwhite origin, and the health care system will have to implement treatment programs for this group to avoid delay in the receipt of treatment," researchers conclude.

Source: Clinical Infectious Diseases 2002;35:1541-1548.

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Cycle Helmets May Not Prevent Brain Injury: Group 

By Pat Hagan

Reuters Health

Tuesday, January 7, 2003

LONDON (Reuters Health) - A controversial new study by a cyclists' action group claims bicycle helmets are not designed correctly to prevent serious brain injury.

The research, published in the journal Accident Analysis and Prevention, concludes there is no scientific evidence to support the compulsory use of helmets and that their design is based on a discredited theory of brain injury.

However, road safety experts strongly disagree with the claims and insist helmets are cutting the number of cycling-related brain injuries.

The same studies had already been used by other researchers from the Australian Transport Safety Bureau as part of a meta-analysis which, in contrast, showed helmets did prevent serious brain injuries.

Researcher Bill Curnow claims the studies were not based on "sound knowledge" of the mechanisms of brain injury and says although helmets may reduce minor head injuries, they do not protect against severe brain damage.

Curnow, president of the Cyclists Rights Action Group in Australia, said the findings call into question Australia's policy of compulsory use of cycle helmets. He reached his conclusions after examining 16 studies on helmet use carried out between 1987 and 1998.

"I do not deny that helmets can protect against superficial injury to the scalp, such as contusions and lacerations," said the head of the Canberra-based group. "Helmets with strong enough shells can protect the skull from damage and the brain from injury. However, most helmets now have soft shells and their capacity to protect the skull is problematic."

The use of cycling helmets by both children and adults has been widely promoted as a road safety measure in many countries round the world. Australia became one of the first nations to legally compel cyclists to wear them in 1992.

The evidence in favor of wearing them has been mounting, although there have been concerns that their use might prompt risky behavior by cyclists who feel a false sense of security while wearing them.

Curnow's research involved looking to see if the 16 studies took into account how brain injuries occurred and whether they were caused by fracture of the skull or angular acceleration--where the brain is damaged as it rotates and slides along the internal surface of the skull.

He claims there is substantial scientific evidence that angular acceleration is the main cause of brain injury.

Yet most helmets are designed to cope with a mechanism called linear acceleration--where the blow causes the brain to accelerate rapidly and strike the skull.

"On this theory, to protect the brain, helmets were developed to absorb some of the energy of impact and reduce the rate of deceleration," Curnow told Reuters Health. "The testing and design of standard helmets continues to reflect the discredited theory that linear acceleration is the dominant cause of brain injury and to neglect rotation.

"Soft helmets grab the surface (of the skull) upon impact, rotating the head and producing high angular acceleration. They are not designed to reduce angular acceleration, the main cause of brain injury."

But road safety experts strongly disagree with the claims and insist helmets are cutting the number of cycling-related brain injuries.

Kevin Clinton, from the UK's Royal Society for the Prevention of Accidents, told Reuters Health: "The Department of Transport in the UK recently published a review which looked at all the research available and again concluded that helmets do help protect cyclists, particularly children.

"Helmets are not the most important cycling safety measure by any means but they are effective."

Source: Accident Analysis and Prevention 2003;35.

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Child's Illness Can Prompt Parents to Stop Smoking 

By Suzanne Rostler

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Children who are hospitalized for respiratory problems are often victims of a parent's cigarette habit. Now, research shows that these hospitalizations may be a prime time to encourage parents to quit.

"(A child's hospitalization) highlights for the parents an additional profoundly negative consequence of their smoking," Dr. Jonathan Winickoff, the study's lead author, told Reuters Health.

He stressed that a child's hospitalization is an appropriate time for doctors to discuss smoking with parents. Therefore, children's hospitals should be offering services and programs like the one evaluated in the current study. The study included 71 smoking parents of children admitted to Children's Hospital in Boston with respiratory disorders.

All parents underwent a motivational interview, received written material and nicotine replacement therapy, telephone counseling and doctor referrals. Winickoff said that the "non-threatening, motivational approach" was key, as it inspired parents rather than making them feel guilty about their smoking.

Two months later about half of the parents said they had tried to quit and that their efforts lasted at least 24 hours. About 20% of parents had quit for one week, according to the report in the January issue of Pediatrics. The overall rate of quitting cigarettes is 2% to 3% a year in the US, the researchers note.

What's more, more than one quarter of parents were still using nicotine replacement therapy after two months and more than one third had discussed quitting with their primary care doctor. Age, race or education did not influence a person's commitment to quit smoking.

"This study demonstrates the feasibility of engaging parents in smoking cessation interventions at the time of child hospitalization for respiratory illness," the researchers conclude.

Secondhand smoke can contribute to asthma, respiratory infections and other health problems in children. Parents who smoke also increase the likelihood that their child will become a smoker.

"I think the study will encourage pediatricians in general to address parental smoking in a more meaningful and comprehensive way than what is currently done," Winickoff said.

Source: Pediatrics 2003;111:140-145.

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Pregnancy May Not Imperil HIV-Negative Prostitutes 

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - New research from India provides more evidence that a small percentage of people can evade infection with HIV (news - web sites), the virus that causes AIDS (news - web sites), despite repeated exposure to the virus.

In a study of prostitutes in India, women who had been repeatedly exposed to HIV without becoming infected themselves had normal pregnancies and gave birth to healthy babies. Neither the babies nor the mothers became HIV-positive during the study.

Researchers are not sure how the women have been able to stay HIV-negative, but they suggest that some people may have some sort of natural immunity against the virus.

Several studies have found that a small number of people who are exposed to HIV over and over again never test positive for the virus. Either their body does not produce antibodies in response to HIV infection or they do not become infected at all.

In the current study, a team led by Dr. Rachana M. Chibber of King Faisal University in Al-Khobar, Saudi Arabia, identified 98 prostitutes who, despite routinely having unprotected sex with many clients, remained HIV-negative for at least three years. Fifty-four of these women, who were all sex workers in Manipur, India, became pregnant.

The effect of pregnancy on a woman's ability to avoid HIV infection is uncertain. So the researchers followed the pregnant prostitutes and compared them to 58 pregnant women living in the same city who were also HIV-negative, but who were not sex workers.

Pregnancy and childbirth were similar for both groups of women, according to a report in last month's issue of the Journal of Reproductive Medicine. Women in both groups remained healthy during pregnancy, and their children were born healthy and HIV-negative.

The effect of pregnancy on HIV infection remains uncertain, according to the investigators. They point out that some studies have shown that pregnancy speeds the progression to AIDS for HIV-positive women, but other studies have not.

What this study shows, according to the researchers, is that there are some people who seem to be protected from HIV infection. Rather than having an HIV infection that failed to show up on lab tests, these prostitutes appeared to have some sort of "natural protective immunity" to the virus, according to the report.

Source: Journal of Reproductive Medicine 2003;47:1016-1020.

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Many Young Docs Repair Incision Without Supervision 

By Alison McCook

Reuters Health

Tuesday, January 7, 2003  

NEW YORK (Reuters Health) - New findings suggest that young doctors nearing completion of their medical training have received little or no formal instruction on how to repair the most common cut in obstetrics and gynecology: the episiotomy, or an incision to widen the birth canal.

What's more, only about 28% of resident physicians in obstetrics and gynecology were supervised by an attending physician when repairing relatively complicated episiotomies.

Although recent reports suggest that episiotomies are not as helpful as once believed, the operation is performed in at least 40% of vaginal childbirths, during which doctors make an incision in the perineum--the soft tissue between the vagina and anus. After delivery, the cut tissues are stitched back together.

While this procedure is often warranted when the baby is stuck in the birth canal or the doctor feels the opening is not big enough, it does carry certain complications.

For instance, the incision to open the birth canal may continue tearing on its own and rip into anal tissue. This can result in anal sphincter lacerations that, in the worst cases, may cause long-term fecal incontinence and the inability to control gas.

In an interview with Reuters Health, study author Dr. Mary T. McLennan of St. Louis University in Missouri said that although episiotomies are currently "falling out of favor," the procedure is still common. "The concerning part of the paper is that of the numbers that are done, most are repaired unsupervised."

During the current study, published in a recent issue of the Journal of Reproductive Medicine, McLennan and her colleagues surveyed resident physicians who were within four months of completing their medical training. Sixty percent said they had not received any academic teaching on the repair of episiotomies. Another 60% said they had received no formal instruction regarding the anatomy of the pelvic floor muscles. Resident physicians often learn by watching more skilled doctors perform procedures.

About 10% of residents said they felt as if they had not been trained enough in how to repair all types of tears in the perineum.

"So we have doctors with no supervision who also are seeing less and therefore doing less, which compounds the potential problem for women if the doctors don't have good, basic anatomy training," McLennan said.

Although the current study did not determine whether this lack of preparedness among medical residents leads to more problems in mothers who receive the procedure, McLennan and her colleagues write that clearly, more training is needed.

The current study is based on the responses of 297 medical residents to a questionnaire that asked students about their academic training in episiotomy, pelvic floor anatomy and types of repair techniques. The students also reported how much hands-on training they had received in this area during their schooling.

"The whole idea for the article was to make doctors aware that our trainees need education," McLennan said. "This is all about preventive care for our women."

The researchers note that only 25% of people responded to the survey, and responses were more likely from residents in smaller programs. The results may have been different if all had responded or more students from large residency programs had participated, they said.

Source: The Journal of Reproductive Medicine 2002;47:1025-1030.

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Treatment May Ease Sleep Terrors, Sleepwalking 

Reuters Health

Tuesday, January 7, 2003

NEW YORK (Reuters Health) - Children who frequently sleepwalk or have sleep terrors may suffer from other underlying, but treatable, problems, new study findings indicate.

According to the report, many children who experience sleepwalking or sleep terrors also have sleep-related breathing abnormalities or restless leg syndrome, a condition marked by an irresistible urge to move the legs. It is possible, then, that these other problems may trigger sleepwalking or sleep terrors, the researchers suggest.

Sleep terrors are similar to nightmares, but occur in a deeper stage of sleep. The episodes, which are similar to a sleepwalker's state, may include screaming and crying, but children typically don't remember what triggered the fear.

The findings may help pediatricians who deal with children with such problems, according to Dr. Christian Guilleminault and colleagues from the Stanford University Sleep Disorders Clinic in Stanford, California. Sleepwalking and sleep terrors are not only disturbing to the child, but can be disruptive to family life. Although both are common childhood problems, it is not clear why they occur or how to treat them.

"In view of the frequency with which sleep-disordered breathing was found in our patients, questions about signs and symptoms of sleep-disordered breathing and restless leg syndrome may be important in clinical practice when recurring sleep terrors or sleepwalking is reported," they conclude.

The study is published in the January online issue of Pediatrics.

In the study, the researchers interviewed parents and reviewed medical data on 84 children aged 2 to 11 with sleep problems and 36 children without sleep problems. The children also underwent a battery of medical tests.

Nearly two thirds of children (61%) who sleepwalked or had sleep terrors had another sleep disorder. Of these children, 96% suffered from breathing disruptions during sleep, known as sleep-disordered breathing. The researchers used a relatively broad definition of the condition, according to the report. The remaining 4% of the children had restless leg syndrome.

The majority of children with sleep-disordered breathing were treated with tonsillectomy or adenoidectomy, and children with restless leg syndrome were treated with medication. Treatment cured all of these children, the study found. In six cases, surgeons refused to perform surgery on children with sleep-disordered breathing, citing the "lack of data on the relationship" between sleep disturbances and enlarged tonsils or adenoids.

However, the "clear prompt improvement" seen in children treated for sleep-disordered breathing provides evidence that sleep disordered breathing "more subtle than that commonly recognized to be abnormal can have substantial health-related significance," the researchers conclude.

Source: Pediatrics 2003;111;e17-e25.

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MONDAY, JANUARY 6, 2003 

Study Links Teen Binge Eating to Suicide Attempt 

By Suzanne Rostler

Reuters Health

Monday, January 6, 2003

NEW YORK (Reuters Health) - Adolescents who go on eating binges and feel out of control and distressed by their behavior may be more likely to attempt suicide than other teens, new study findings suggest.

While more research is needed, including studies investigating psychological factors that might be related to overeating and suicide, the report found that more than one quarter of teens diagnosed with binge eating reported attempting suicide in the past.

Specifically, nearly 29% of girls and 28% of boys who reported overeating and feeling distress and a loss of control said they had tried to kill themselves, compared with less than 10% of those who did not overeat.

Adolescents who overate also tended to be overweight or obese, to say they had tried to diet in the past year, and to feel that their weight was very important to their self-image. Not surprisingly, they were less satisfied with their bodies and themselves and were more depressed than their peers who were not binge eaters, according to researchers led by Dr. Diann M. Ackard from the University of Minnesota in Minneapolis.

The findings, published in the January issue of Pediatrics, support previous research showing that overeating among adolescents is linked with obesity and may reflect a number of underlying psychological problems. As adolescent obesity has swelled by more than 75% over the past three decades, understanding exactly how the cycle of dieting and overeating is related to weight gain may be relevant to increasing numbers of people.

"Professionals and concerned adults need to identify youth who overeat by asking questions about eating behaviors and providing interventions for youth who overeat or who need to (develop) weight management skills," Ackard told Reuters Health.

Researchers interviewed nearly 5,000 students attending public middle schools and high schools in Minnesota, and measured their weight and height. About 17% of girls and 8% of boys reported that they binged on food at times. But 3% of girls and 1% of boys in the study met the criteria for binge eating syndrome, a diagnosis made when an adolescent overeats and feels a loss of control followed by feelings of distress.

Among girls, African Americans were the least likely to report overeating and Hispanics the most likely to report overeating. Among boys, whites were the least likely and Asian Americans were the most likely to report overeating, the study found.

Adolescents who overate tended to have a higher body mass index (BMI), a measure of weight in relation to height, and to believe that a person's weight and shape are the most important factors shaping self-esteem.

"Overeating, regardless of the individual's weight, is associated with a number of behavioral and psychological risks," Ackard said in an interview.

Source: Pediatrics 2003;111:67-74.

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Teaching Old Drugs New Tricks 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- Inhaled insulin for diabetics (news - web sites). Nanoparticles that detect the onset of disease before it develops. Implantable microchips that dispense precise amounts of medicine at exactly the right time.

If researchers have their way, swallowing a bitter pill may eventually become a thing of the past.

Across the world, researchers are working on developing new methods of delivering drugs that are both more effective and more pleasant for the patient.

The drug-delivery field is booming. In the last 20 years, drug delivery has gone from a small niche field to a $20 billion industry, according to the American Chemical Society.

You're probably familiar with some of the advances already made: nicotine patches to help smokers kick the habit, and nasal inhalers to treat allergies.

But those are only the beginning, said Robert Langer, a professor of chemical and biomedical engineering at Massachusetts Institute of Technology (news - web sites) in Cambridge, Mass.

"The industry has grown tremendously," Langer said. "Better pills. Patches. New types of aerosols. It's really just taken off."

Like with a new drug, new drug-delivery methods have to undergo extensive testing to prove their safety and gain U.S. Food and Drug Administration (news - web sites) approval.

Diabetics, for example, have used insulin injections to control their blood sugar for decades. Researchers are currently testing an inhaled form of insulin to do away with dreaded needles.

But before it's approved for market, researchers must prove that inhaling insulin won't cause other problems, such as damage to the lungs.

Here's a rundown of what the American Chemical Society views as some of the most promising new research in drug-delivery technology:

The Problem With Pills: There are two major drawbacks to taking an ordinary medicine orally, Langer said.

The first is that a pill's strength isn't evenly distributed throughout the day -- there can be a peak when it's first digested and a valley when it begins to wear off.

Researchers are working to develop extended-release pills that deliver the medicine at a more steady pace, or that can tailor the dosage to specific times of the day when it's needed most. One of the first available is called Concerta, a once-a-day pill for Attention Deficit Hyperactivity Disorder, Langer said.

The second difficulty with taking medicine orally is that the stomach simply devours many compounds. That's why insulin, for example, has to be injected and not swallowed.

Researchers are working on pills that can survive the stomach and get to the part of the body where the medicine is needed, Langer said.

Your Very Own Pharmacy: Langer and other researchers are working on developing a microchip that could be implanted under the skin and programmed to act like a tiny pharmacy, directing the release of drugs exactly when you need them.

The chip has tiny reservoirs that could hold several types of medicines. The chip could also transmit the information to the doctors office or hospital.

Seeking Out And Destroying Disease -- Before It Starts: Drug-delivery researchers are working on developing nanoparticle sensors -- tiny, atom-sized particles that course through the bloodstream and can detect compounds that may be markers for disease.

Nanosensors might be on the lookout for excess glucose, a sign of the onset of diabetes, or excess cholesterol. The particles could trigger a system (such as a microchip) that would release a drug to fix the chemical imbalance. The nanoparticles are biodegradable and will self-destruct in a few days, Langer said.

Real-Life Star Trek: On the TV show, Bones, the ship's doctor, gave patients medicine by painlessly zapping them with a gadget.

Soon, that may be more than science fiction.

Researchers have discovered that placing an ultrasound on the skin for about 15 seconds temporarily disorders the fatty substances in the skin, making it more permeable. This allows larger molecules to pass through and enter the blood stream.

The aim is to one day use ultrasound to deliver medicine -- insulin, perhaps, or anesthesia directly on the source of pain.

Ultrasound could also help non-invasively gain information about what's going on in the body. One day, diabetics might be able to zap their skin with an ultrasound in the morning, place a sensor over the location and track their blood sugar. The current method is pricking the skin and extracting a droplet of blood.

When All Else Fails, Grow a New Organ: Many diseases cannot be treated by drugs, Langer said. The second major area of drug-delivery research is tissue engineering, or growing new cells or new organs in the laboratory.

For example, if a person is dying of liver failure, the only way to treat them is by transplantation. For that, they have to wait for someone else to die, Langer said.

But what if a person could receive new liver cells that would grow and regenerate the damaged organ?

It's not such a far-off hope.

Cells are intelligent, Langer said. Given the right circumstances, they will organize themselves to take over the function of the cells in the area where they are placed.

Langer and his colleagues have developed a polymer support system, similar to a scaffolding, that the cells can use as a guide. The scaffolding gradually degrades, leaving only the living cells.

What To Do

Read more about using ultrasound to deliver medicine at Wired. Read more about tissue engineering at Tissue-Engineering.net.

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Use Tamiflu to Prevent, Not Treat, Flu: UK Report

By Richard Woodman

Reuters Health

Monday, January 6, 2003

LONDON (Reuters Health) - Roche's flu drug Tamiflu (oseltamivir) should be used only to prevent infection, not for treating it, according to Britain's Drug and Therapeutics Bulletin.

The oral therapy is licensed for treating patients with early influenza-like symptoms and for prevention in people who have had close contact with someone with influenza.

But the bulletin, an independent review for prescribers, said it seemed to offer only "modest benefits" as a treatment in otherwise healthy adults and children.

It shortened such illness by around 1-1.5 days if started within 36-48 hours of symptom onset, and appeared to reduce the incidence of common complications, notably bronchitis and otitis media.

But fully published randomised controlled trials had excluded patients most at risk from influenza and serious complications, and there was insufficient evidence of benefit in these groups, the bulletin notes.

"On current fully published evidence, we cannot recommend oseltamivir for the treatment of acute influenza-like illness," it concluded.

The report said that vaccination remains the cornerstone of prevention but oseltamivir seemed to offer additional protection to people in nursing homes or similar institutions.

"In the event of an outbreak in such homes, and in other situations where influenza could spread rapidly among people at high risk of developing complications, it seems reasonable to offer prophylaxis with oseltamivir to the residents and the staff, both unvaccinated and vaccinated."

Oseltamivir is the second in a family of drugs called neuraminidase inhibitors to be licensed after GlaxoSmithKline's inhaled drug Relenza (zanamivir), which is licensed only for treatment. The bulletin previously concluded there is insufficient evidence to recommend its use.

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Lead linked to delinquent behavior  

From the Science & Technology Desk
United Press International

Monday, January 6, 2003

PITTSBURGH, Jan. 6 (UPI) -- Lead long has been known to lower intelligence and cause learning disabilities, but a new study released Monday shows the toxic metal also might contribute to juvenile delinquency.

In the study, delinquent children were found to have higher levels of lead in their body than non-delinquent children, Herbert Needleman, principal investigator and professor of child psychiatry and pediatrics at the University of Pittsburgh, told United Press International. The finding suggests children exposed to the metal could be at a higher risk of delinquency, he added.

"One of the most important facets about this work is it really shows that lead's affects on behavior can be even more important that its effect on cognition," Annette Kirshner of the National Institute of Environmental Health Sciences in Research Triangle Park, N.C., told UPI.

Needleman's group found that 200 youths convicted in the Juvenile Court of Allegheny County, Pa., had significantly higher levels of lead in their bones than non-delinquent youths from high schools in the Pittsburgh area. Bone lead levels in the delinquent kids came out to 11.0 parts per million, much higher than the 1.5 ppm in the non-delinquent group.

The study, which appears in the Jan. 6 issue of the journal Neurotoxicology and Terotology, agrees with other research begun in the late 1980s. Researchers have been following a group of teenagers since birth and have found "the higher the lead content the more the delinquency there is amongst the children," Kirshner said.

Previous research by Needleman also had suggested higher lead levels were associated with aggressive behavior. A 1996 study found boys with raised lead levels were prone to bullying and vandalism.

"Mothers of lead-poisoned children will tell you that their children's behavior changes after exposure," Needleman said. They become aggressive and inattentive.

"The most import thing that could be done is to remove lead from the environment before it gets in the children," he said. The biggest source of lead is paint in houses. "There are 30 million houses (in the United States) built before 1950 and almost all of them have lead-based paint in them," he said. About 4 million of those houses are deteriorating and those represent a serious danger to children because the paint is chipping, increasing the chance of exposure, he said. Most of those dilapidated houses are in poor neighborhoods but some are also found in middle class areas.

Kirshner said lead fittings and pipes are another source of exposure and these plumbing components were still in use until the 1990s. In order to address the problem, "society really has to clean up deteriorating properties" and make them lead-safe, she said.

For the nearly 900,000 U.S. children estimated to be suffering from lead exposure, Kirshner said a program of nutritional supplementation and social enrichment could help reverse some of the damage. "It's not impossible but it's very hard to undo the effects of lead once a child is exposed," she said, adding that is why it is important to prevent exposure in the first place.

 (Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)

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Ballplayers Strike Out When It Comes to Cholesterol

Reuters Health

Monday, January 6, 2003

NEW YORK (Reuters Health) - Despite their status as elite athletes, a study of 25 Major League baseball players reveals that a significant proportion have potentially life-threatening levels of fat and cholesterol in their blood.

About one quarter of players had high cholesterol, defined as more than 200 milligrams per deciliter of blood (mg/dl). Another 12% had elevated levels of blood fats known as triglycerides, which can boost the risk of heart disease.

Almost 40% of the players had relatively high levels of low-density lipoprotein (LDL) cholesterol, the dangerous form of cholesterol that can clog arteries. And almost half of the players tested had low levels of high-density lipoprotein (HDL) cholesterol, which can protect people from developing heart disease.

Men who make it to the Major League are now in very good physical shape compared to athletes in the past, who often smoked and were overweight, study author Dr. John Cantwell of the Morehouse School of Medicine and Emory School of Medicine in Atlanta, Georgia writes.

Cantwell is a team physician for the Atlanta Braves, and conducted the analysis in February 2002, as part of the pre-season physical exam. He found that none of the players currently smoked cigarettes, and only one would be considered obese using height or weight charts.

However, Cantwell notes that even young, healthy athletes can develop heart disease. "The recent sudden death of 33-year-old St. Louis Cardinal pitcher Darryl Kile is a stark reminder that this disease can strike even the young, gifted athlete," he writes.

Some players may have low HDL levels as a result of using anabolic steroids, Cantwell notes, which previous research has suggested can reduce HDL cholesterol in the blood. Although just how many players use steroids is unclear, Cantwell notes that a former Major League player at one point estimated that around half of players do.

As a result of the current study, reported in the recent issue of the American Journal of Cardiology, players with high levels of fat in their blood received information about cutting back on cholesterol- and fat-laden foods. One player with high cholesterol and a family history of early heart disease was put on a cholesterol-reducing drug.

Not all food served to athletes is healthy, Cantwell notes, and "we can do even better in providing healthier food choices in the clubhouse."

Players might also benefit from meetings with registered dietitians to teach them the importance of healthy eating, he notes.

Source: American Journal of Cardiology 2003;90:1395-1397.

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Zinc About This

HealthScoutNews

Monday, January 6, 2003

(HealthScoutNews) -- If you take zinc -- in lozenges or mouthwashes -- when you have a cold, you might try also using it every once in a while when you feel better.

That's because it helps reduce bad breath.

According to the French journal Revue De Stomatologie Et De Chirurgie Maxillo-Faciale, the main cause of chronic bad breath -- not just the type you get after eating garlic -- is a group of compounds that contains sulfur.

Because zinc binds to sulfur, it seems mouthwashes, gum and toothpaste that contain zinc can help reduce bad breath better than mints or most other compounds.

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Most Parents Say 'No Way' to Toy Guns

 

By Charnicia E. Huggins

Reuters Health

Monday, January 6, 2003

NEW YORK (Reuters Health) - While most parents do not allow their children to play with toy guns, nearly one third of parents--white parents in particular--believe that it is generally OK for their child to play with toy guns, or OK in rare cases, new study findings show.

Fathers and parents of boys also seem to hold more lenient beliefs about toy gun play, according to the report.

"Parents have different views on toy gun play and have different parenting practices," lead study author Dr. Tina L. Cheng of Johns Hopkins University in Baltimore, Maryland told Reuters Health. This study "calls attention to the issue of toy gun play and that there are differing views on the issue," said Cheng, who conducted the study while at Children's National Medical Center in Washington, DC.

Previous studies on the topic have yielded controversial results, with some finding an association between toy gun play and aggressive behavior. Yet few researchers have looked at parents' attitudes and behavior concerning the issue.

Cheng and her colleagues investigated parents' views about toy gun play in a study of 830 parents. Most of the parents had at least one child above the age of one year.

Altogether, roughly two-thirds of the parents agreed that it was never "OK for a child to play with toy guns," and a similar proportion said they never allowed their children to do so, the researchers report in the January issue of the journal Pediatrics.

However, white parents were four times as likely as parents of other races to say it was "OK" for their child to play with toy guns, the report indicates. Fathers and parents of boys, respectively, were also more likely to say toy gun play was "OK" than were mothers and parents of girls.

These groups were also more likely than their counterparts to say they allowed their own children to play with toy guns.

"As parents we have choices of what to buy our children," Cheng said. "Given the choice I would opt for toys that encourage positive creativity and imagination instead of toy guns that encourage shooting and destruction."

Still, whether or not toy gun play is allowed, all parents should discuss gun safety with their children and teach their children that problems can be solved without guns, Cheng advised. They should also explain to their children the difference between toy guns and real guns, and warn their children against touching real guns.

"I would caution that toy guns with projectiles can be dangerous and deadly as can confusion between toy guns and real guns," Cheng said. "If allowing toy guns, I would advise against toy guns with projectiles and toy guns that look like real weapons."

The American Academy of Pediatrics recommends that pediatricians counsel parents about the dangers of toy guns, including injury and death from projectile or air trauma and hearing damage due to some toy guns' loud sound levels.

Source: Pediatrics 2003;111:75-79.

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Magnet Aids Doctors Fixing Brain Diseases

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, January 6, 2003

WASHINGTON - Dr. Demetrius Lopes snaked a thin wire with a tiny magnet on its tip into an artery in Paul Kelsey's groin and threaded it all the way up into his brain.

Aided by a helmet-shaped magnet hung over Kelsey's head, Lopes guided the wire through twists and turns deep in the brain, finally reaching swollen blood vessels that were giving the Chicago man double vision. A few squirts of glue to seal off the excess blood flow, and Lopes pulled the wires back out — surgery done.

Normally, curing Kelsey's disorder would require operating through a hole drilled in his skull. But doctors now are creating ways to fix brains from the inside, no drilling required. And using magnets as a guide, while still highly experimental, could let them go into deeper, trickier areas than ever imagined to treat aneurysms, strokes and other serious brain ailments.

Indeed, neurology may be poised for a shift as important as cardiology underwent years ago when heart specialists began using balloons instead of bypass surgery to unclog heart arteries.

The field is called endovascular surgery, operating by snaking through blood vessels. It's not as easy in the brain as in the heart. Brain blood vessels are smaller and more twisted. Plus, they float in brain fluid that makes pushing wires through them like operating inside a bowl of gelatin.

Bend the wire the wrong way and miss the brain target, and the doctor must pull out the wire — it can stretch more than 6 feet — and start over. (They start from the groin, not closer to the head, because it provides a wide, easy-to-thread artery.)

There are only 300 endovascular brain specialists in the country, compared with about 6,000 traditional brain surgeons.

"The reason there are so few doing what we do is it's hard and dangerous," says one endovascular specialist, Dr. Christopher Moran of Washington University in St. Louis, which pioneered research on the magnet guide. "If this (magnet) makes it easier, therefore it becomes safer and therefore it makes it easier for patients to gain access" to drill-free brain surgery.

Experiments to prove if the magnet, Stereotaxis Inc.'s Telstar system, works in the brain are under way at Washington University and Rush-Presbyterian-St. Luke's Medical Center in Chicago. While the experiments will take several years, there's optimism because the Food and Drug Administration (news - web sites) recently approved the Telstar's use by heart specialists to map the source of irregular heartbeats. In the heart, the system seems to speed up those doctors' work.

In the brain, even smaller Telstar wires "may extend our reach to treat lesions considered untreatable today," says Dr. Joel MacDonald of the University of Utah, who is monitoring the technology for the Congress of Neurological Surgeons.

Take Kelsey, a roofer who suddenly developed double vision whenever he looked down. Brain scans spotted a fistula, a mass of malformed blood vessels that were swelling and putting pressure on crucial vision nerves. Last spring, Lopes, a Rush neurosurgeon, snaked a catheter with repair glue to the spot. But the fistula was too deep and twisted for Lopes to manually push the catheter to its origin, and the swelling returned.

Last month, Lopes tried again with the Telstar. Following his route on an X-ray, Lopes used the magnets like a steering wheel: To navigate twists and turns, the doctor increased or decreased current flowing from superconducting magnets hung over Kelsey's head to the magnet-tipped guidewire in his artery.

This time, the wire successfully pulled a catheter to the fistula's core, giving Lopes a tunnel through which to squirt healing glue. If the three-hour procedure worked, Kelsey's vision should return to normal in six months; he claims a small improvement already.

The magnet's use may not just be for inside blood vessels. Even drilling through the skull doesn't always allow neurosurgeons to reach just the brain tissue they want without damaging nearby spots. Researchers also are studying whether the magnet guide could provide more precision in those cases, possibly helpful in treatment of Parkinson's disease (news - web sites) or brain tumors.

As for no-drill treatment, it is a controversial field, not around long enough yet for endovascular fixes to have proven as durable as open-brain methods.

But more patients each year seek no-drill treatments. If the magnet system ultimately is proved to fix deeper, more complicated problems, "what's going to drive it is the public," says Moran. "Most people would rather have us work through the vessel than have their head opened."

Editor’s Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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The Formula for Happiness?

Reuters

Monday, January 6, 2003

LONDON (Reuters) - If you're happy and you know it then it's clearly a result of: P + 5E + 3H.

A pair of British researchers said Monday they had worked out a simple equation to quantify happiness that could put an exact figure on the emotional state.

After interviewing 1,000 people, the researchers--a psychologist and a self-styled "life coach"--concluded that happiness equals P + 5E + 3H.

In the equation, P stands for Personal Characteristics (outlook on life, adaptability and resilience); E for Existence (health, friendships and financial stability) and H represents Higher Order (self-esteem, expectations and ambitions).

Psychologist Carol Rothwell co-authored the report with Pete Cohen. They asked interviewees--a mix of men and women all over 18 years old--to choose five scenarios that made them more happy or less happy from a list of 80 different situations.

They also asked a series of questions about their own natures, outlooks and situations.

Not surprisingly, the results showed that men and women found happiness in different ways.

Sunny weather, being with family and losing weight were more of an influence on women's happiness, while romance, sex, hobbies and victories by their favorite sports teams were more important to men.

"This is the first equation that enables people to put a figure on their emotional state," Rothwell said. "The findings show that certain events, such as job promotion, can impact positively on your overall happiness."

The study was commissioned by a holiday company that wanted to understand what made people happier.

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Testosterone Buoys Spirits of Depressed Men

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- A testosterone boost may lift the moods of depressed men who don't respond to antidepressants.

A study in the latest issue of the American Journal of Psychiatry says that men who don't respond to antidepressants may have low testosterone levels, and efforts to restore those levels to normal seem to improve their depression.

In screening the testosterone levels of 54 depressed men who didn't benefit from antidepressants, researchers at McLean Hospital in Belmont, Mass., found that a relatively large number -- 43 percent -- of the men had low testosterone levels.

The researchers gave 19 of those men a testosterone replacement gel along with antidepressants, while the other five received antidepressants and a placebo. The subjects were between the ages of 30 and 65.

Over the next eight weeks, those who received the testosterone gel showed significant improvements compared to those who didn't get the gel. Areas of improvement included mood, feelings of guilt and anxiety, as well as improved sleep, appetite and libido.

Side effects from the treatment were modest; one man withdrew from the study due to difficulty urinating.

The researchers caution that the findings are preliminary, and larger studies are needed. However, they say the initial results suggest that men who don't respond to antidepressants may have reduced testosterone levels, and doctors should consider screening for that problem.

McLean Hospital is a psychiatric affiliate of Harvard Medical School (news - web sites).

More information

The National Institute of Mental Health offers information on the difference in depression between men and women.

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Pfizer Settles Over Kids' Antibiotic Ads

By Michael Gormley

Associated Press Writer

The Associated Press

Monday, January 6, 2003

ALBANY, N.Y. - Pfizer Inc. reached a $6 million settlement with 19 states Monday that requires the drug maker to change how it promotes its best-selling antibiotic Zithromax.

The states had accused Pfizer of misrepresenting the performance of the drug, which is used primarily to treat ear infections in children and respiratory ailments in adults.

Zithromax works in fewer doses and fewer days, but that doesn't make it superior to other antibiotics, said Christine Pritchard, spokeswoman for Attorney General Eliot Spitzer. She said Pfizer failed to disclose that physicians weigh other factors when prescribing treatment for ear infections.

Pfizer admitted no guilt in the settlement.

"Pfizer maintains that all of the advertising and promotional materials for Zithromax have been consistent with the medicine's labeling, which is approved by the U.S. Food and Drug Administration (news - web sites)," Pfizer spokeswoman Mariann Caprino said.

Pfizer will pay $2 million toward public service announcements through March 2005 and promised to inform customers about factors physicians consider when prescribing antibiotics. It will also provide $4 million to cover the cost of the states' investigations.

Besides New York, states pursuing the settlement were Arizona, Arkansas, California, Connecticut, Florida, Kansas, Maryland, Massachusetts, New Mexico, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Vermont and Wisconsin.

Pfizer said it settled to dispose of the case expeditiously. The company said physicians have written 41 million prescriptions in the United States for Zithromax.

On the Net: http://www.pfizer.com

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Fish Keeps Arteries Fit

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- A new study of smokers offers yet another reason for heart-conscious individuals to eat fish -- it is rich in an amino acid that relaxes blood vessels.

The amino acid is taurine, which is plentiful in all species of fish, says Dr. David J. Bouchier-Hayes, a professor of surgery at Beaumont Hospital in Dublin, Ireland. He is lead author of the study, which appears in tomorrow's issue of Circulation.

When young smokers were given taurine supplements equal to that found in an average serving of fish, their blood vessels relaxed as much as those of nonsmokers, he says.

Boucher-Hayes is quick to add that smokers shouldn't assume they can protect themselves against heart disease and stroke by eating fish or taking taurine supplements.

"The responsible thing to do in relation to smoking is to give up smoking," he says. "Cigarette smoking has multiple effects on the blood vessels, so it is unwise to say you can continue to smoke if you eat fish."

However, the study carries a lesson for some nonsmokers who are at higher risk of cardiovascular disease, such as diabetics (news - web sites), Bouchier-Hayes says. A diet with lots of fish -- or taurine supplements -- can help prevent a condition that is one of the earliest signs of trouble.

The condition is endothelial dysfunction, in which the normally flexible arteries become rigid and narrow.

"A normal artery will dilate by about 10 percent in response to increased flow, such as that caused by physical activity," Bouchier-Hayes explains. "That dilation is controlled by the inner lining of the blood vessels, the endothelium. It senses the increased flow, and in response increases its release of nitric oxide, which seeps through the blood vessel wall and induces relaxation in the muscles around the blood vessel, increasing their diameter."

That response doesn't occur in smokers, which is one reason why they are at high risk of heart attack and stroke.

In the study, Bouchier-Hayes and his colleagues gave 15 young smokers taurine supplements and compared the function of their blood vessels with that of 15 nonsmokers. In tests before they took the supplements, the smokers' blood vessels did not enlarge at all, while those of the nonsmokers did. When the smokers took the taurine supplements, the amount of blood-vessel enlargement was the same for both groups.

Vitamin C supplements also acted to enlarge the blood vessels, but "the effect of taurine was much greater," says Fiona M. Fennessey, a researcher who participated in the study and now is a clinical professor in radiology at Brigham and Women's Hospital in Boston.

Fennessey advocates a fish-rich diet. "Instead of popping pills all the time, it's preferable to increase your intake of fish," she says.

Dr. Sidney Smith, professor of medicine at the University of North Carolina and past president of the American Heart Association (news - web sites), says the new study "adds to the growing body of evidence that fish oils can have a beneficial effect on blood vessels."

"And it emphasizes more than ever the importance of not smoking or of stopping smoking. Given the choice of eating a lot of fish and stopping smoking, people would be well advised to stop smoking," Smith says.

What To Do

You can learn more about the healthy effects of fish in the diet from the American Heart Association. For more on the link between smoking and heart disease, visit the Cleveland Clinic Heart Center.

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Appalachia Welcomes Methadone Clinics

By Roger Alford

Associated Press Writer

The Associated Press

Monday, January 6, 2003

PAINTSVILLE, Ky. - In other places, attempts to open methadone clinics for drug addicts have spawned protests, even court fights. Not in Appalachia.

Residents and political leaders, grappling with an epidemic of OxyContin addictions, have welcomed at least 10 methadone clinics in a region that previously had none.

One of the newest clinics opened in the former office of a Paintsville physician who was arrested last year for allegedly overprescribing OxyContin and other painkillers to patients in eastern Kentucky.

The change of tenants has made a dramatic change in the small town. Traffic jams are no longer the norm around Jefferson Avenue where people seeking prescription drugs used to park. Since the methadone clinic opened, the parking lot has remained uncrowded and calm.

Police Chief Doug Wallen said he expected an outcry when the methadone clinic opened. "We haven't had the first complaint," he said.

Similarly, clinics that have opened in the Kentucky cities of Hazard, Morehead and Corbin did so without opposition, as did one in Cedar Bluff, Va., and five in the West Virginia cities of Charleston, Clarksburg, Parkersburg, Martinsburg and Beckley.

New clinics have opened in the Virginia cities of Richmond and Charlottesville, as well as other cities outside central Appalachia to serve people addicted to OxyContin and other opioids.

OxyContin became popular in eastern Kentucky because of the economically depressed areas, police have said. Residents with insurance or Medicaid could get the pills for free. The drug's popularity grew for its quick high that produces effects similar to the more expensive drug heroin.

But in some communities outside Appalachia, methadone clinics haven't been so warmly welcomed because of concerns that addicts may bring an increase in criminal activity in the neighborhoods where they locate. An attempt to open a methadone clinic in Covington, Ky., a Cincinnati suburb, spawned a four-year court battle that ended in June when the 6th U.S. Circuit Court of Appeals (news - web sites) ruled in favor of the clinic. City officials, responding to the concerns of residents, had gone so far as to amend a zoning ordinance to keep the clinic from opening.

"Methadone can be controversial because some people see it as trading one drug for another drug," said Merritt Moore, adult treatment coordinator in the West Virginia Division of Alcoholism and Drug Abuse. "These clinics opened without fanfare. It went smoothly."

Eastern Kentucky sociologist Roy Silver, said nearly everyone in mountain communities have been affected in some way by OxyContin abuse, often because a friend or relative got hooked. The methadone clinics have been more warmly welcomed, he said, because of the perceived help they can provide.

"OxyContin abuse has been so devastating," Silver said. "It's the most serious drug problem that's ever hit the region, and that's why people are more amenable to having something like their in their communities."

Methadone is used to curb the cravings of people addicted to heroin, morphine and other opioids, including the painkiller OxyContin, which became the drug of choice in Appalachia over the past three years. Methadone, when used for treatment of opioid addiction, can be dispensed only in the special drug-treatment clinics.

Harlan County Sheriff Steve Duff said he opposes the use of methadone because addicts have learned to mix the drug with others to achieve the kind of euphoric high that OxyContin gives.

"To me, it's just replacing one drug for another drug," he said. "Any drug you put out there right now, they're going to abuse it."

Former Mayor Robin Cooper said he expected at least some opposition when word got out that a methadone clinic had applied for a business license in his town. He said he received four phone calls from people who had more questions than concerns.

"People are able to accept it because it is a needed service," said Cooper, whose term ended in December. "We've got a problem in eastern Kentucky that has to be dealt with."

Clients pay an average of $8 to $10 a day for methadone at the private, for-profit clinics.

Michael Townsend, head of the substance-abuse division of the Kentucky Cabinet for Health Services, said the methadone clinics opened in the smaller cities specifically to serve OxyContin addicts.

"People who have switched over from OxyContin to methadone are people who have gotten addicted probably because of legitimate pain issues," Townsend said. "They're not as prone to be involved in criminal activities."

Jim Rectenwald, a substance abuse counselor for Paintsville Professional Associates, said methadone is key in the fight against the OxyContin epidemic in the mountain region.

Rectenwald said methadone was the best option for allowing those addicted to OxyContin to function. He said that was important because OxyContin quickly took hold in the region.

"It was a brand new drug that was everywhere at once," he said. "The opiates just really dig in, like a worm under the skin."

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Aging Boomers' Medical Costs May Be Less Than Thought

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- While budget analysts fret over the anticipated costs to Medicare and the medical system for caring for aging baby boomers, one new study suggests that growing older may not be nearly as expensive as once thought.

Researchers with the University of North Carolina at Chapel Hill say that by the time baby boomers grow into their 80s, they will have passed the age of being considered for costly life-saving medical procedures.

In addition, while nursing home expenditures do indeed increase with age, the increase tends to slow near the end of life, when increases in inpatient care rise only slightly.

Comparatively, expenses involved in caring for a younger person during, for instance, what will be the last two years of their life, are much greater because so many more expensive and risky efforts are made to try to save the patient's life, says the study.

The findings come from a look at trends in the costs of caring for the elderly, found in data on 25,954 elderly people from the federally funded 1992-1998 Medicare Current Beneficiary Survey.

The researchers found that, overall, the average monthly health-care expenditure per person in 1998 dollars was about $720, of which Medicare paid $429.

Among those who died, the cost was about $3,170 monthly, whereas those who survived incurred about $590 in health expenses.

Significantly, the figures showed that in the month before death, the cost for people aged 65 to 74 averaged about $7,580, but the cost for those 85 and older was lower -- about $5,254.

The researchers conclude the figures are an encouraging sign that medical costs incurred by the elderly may not increase at the rate some have feared. However, they caution that the potential costs of technological advances and new drugs make predicting health-care expenses a very tricky business.

The study appears in the January issue of the Journal of Gerontology.

More information

Here's extensive health information from the National Institute on Aging.

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Soap, Water for Umbilical Stump May Boost Infection

Reuters

Monday, January 6, 2003

 

CHICAGO (Reuters) - Using soap and water instead of anti-bacterial agents to clean newborns' umbilical stumps can increase the risk of infection, according to a Canadian study published on Monday.  

Using simple soap and water has gained favor in recent years because of concerns that an anti-bacterial mixture of three dyes, commonly used in conjunction with alcohol, could be carcinogenic, the report said.

Also, newborns today spend less time in hospital nurseries and more time in their mothers' rooms, so doctors felt that they were less likely to be exposed to staph infection that nurses can carry from baby to baby. Some felt that the anti-bacterial treatment was unnecessary.

But a study of 766 newborns found there was a higher risk of infection among babies cleaned with just soap and water, said researchers at the University of British Columbia and the Vancouver/Richmond Health Board.

One infant washed with soap and water developed omphalitis, an infection that can lead to an often-deadly condition called necrotizing fasciitis, the study found. In general, infants treated with soap and water had more bacteria in the stump area, including E. coli, Staphylococcus aureus and streptococci, it added.

"Our study suggests that omphalitis remains a clinical entity and that there is potential risk in discontinuing bacteriocidal treatment of the umbilical cord stump," said the report published in the January issue of Pediatrics, the journal of the American Academy of Pediatrics.

"Cessation of bactericidal care of the umbilical stump must be accompanied by vigilant attention to the signs and symptoms of omphalitis," it added.

In addition to animal studies indicating that the antibacterial agents--a combination of brilliant green, proflavine hemisulphate and crystal violet dyes--could cause cancer, parents and nurses often complain about the black color and brittle appearance of the stump, the study said.

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Caffeine Tied to Sleepless Students

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- Excessive caffeine consumption might be disturbing teenagers' sleep patterns -- and school performance -- and schools should take that into account when allowing them access to caffeine-containing soft drinks, a study suggests.

"This issue has never been raised in a public forum," says Dr. Charles P. Pollak, a professor of neurology at Ohio State University who reports the study in the January issue of Pediatrics. "In the past, the availability of soda has been criticized on a nutritional basis, the empty calories they contain. Our findings suggest that an issue to be considered would be the caffeine content of soft drinks."

Pollak's study enrolled 191 students in the seventh, eighth, and ninth grades, who kept diaries of their intake of caffeine-containing foods and beverages and their sleep time for two weeks. "Higher caffeine intake in general was associated with shorter nocturnal sleep patterns, increased wake time after sleep onset and increased daytime sleep," the journal report says.

This isn't a critical problem, Pollak acknowledges. "We're not raising a major alarm, but it is worthy of investigation," he says.

It appears that only a small percentage of teenage students consume enough caffeine-containing soft drinks to affect their school performance, and "there is no estimate of how prevalent the problem might be," Pollak says. "But before schools install soda machines or continue allowing their use, one of the things to be considered is the possible effects of caffeine," he adds.

What would be needed to clinch -- or disprove -- the case against soft drinks would be a carefully controlled study in which sleep patterns and school performance would be judged against the amount of caffeine intake of young people, Pollak says. "I think such a study is feasible," he says.

It's a false alarm, says Sean McBride, a spokesman for the National Soft Drink Association. "It's really very difficult to tell from this study what the impact on caffeine intake is on teenagers," he says. "There really is no way to tell whether caffeine or other factors are responsible for those interrupted sleep patterns."

The journal report says there are "a lot of deficiencies and limitations" of the study, such as the small number of students and lack of independent verification of caffeine intake, McBride says.

But the industry does recommend wise drinking habits, he adds. "Our advice is that all beverages should be consumed in moderation. And if there are any concerns about health, including sleep patterns, you should consult your family doctor or appropriate health care provider," McBride says.

What To Do

You can learn more about caffeine from the University of Washington, while the American Academy of Pediatrics has a page on dealing with school mornings.

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Parents: Beware of Toys That Can Suction, Suffocate

 

Reuters Health

Monday, January 6, 2003

NEW YORK (Reuters Health) - Certain hollow, container-type toys that can cover the nose and mouth of young children can lead to suffocation and death, a new report warns.

The study is based on a review of incidents reported to the US Consumer Product Safety Commission (news - web sites) and cited in medical literature over a seven-year period. All cases involved children under 5 years who got hold of semi-rigid hollow objects that covered the nose and mouth simultaneously and formed an airtight seal.

The analysis found a total of 17 incidents in which 8 children, aged 4 months to 24 months, died. In all but one incident, the child was found suffocated in a playpen or crib with the object suctioned to his or her face. The objects ranged from 6.4 centimeters (cm) to 9.7 cm in diameter and from 4.2 cm to 5.1 cm deep.

In one case a 13-month-old girl's nose, mouth and chin were covered with a half-ball-shaped plastic toy piece, part of a toy designed to separate into two hemispherical pieces when opened. The girl was found unresponsive in a playpen, and later died.

Nine incidents were not fatal because a parent intervened in time. In all but one case, significant physical effort was required to remove the object from the child's face, report Dr. Suad Wanna Nakamura from the US Consumer Product Safety Commission in Bethesda, Maryland, and colleagues.

For instance, a 3-year-old girl was left with marks on her face for about 1 week after her mother found the girl unconscious in her bed and pulled off a container component of a toy ball covering her nose and mouth.

The findings in the January online issue of Pediatrics underscore the potential danger of certain objects, and suggest that parents and caregivers should not allow infants to play with container-type objects when they are left unattended.

Young infants are particularly vulnerable because their facial features, such as a round face, fleshy cheeks that are easily compressed, and a small jawbone, increase the risk that an airtight seal can form. Improved hand-to-mouth coordination and the tendency to put objects in the mouth around 4 months of age may also make these types of objects particularly dangerous for babies, the authors note.

Product safety improvements, for example including ventilation holes in certain toys to prevent a seal from forming if the face becomes covered, could lessen the danger posed by such toys, the researchers write.

"An awareness of this hazard and the products involved is necessary among consumers, toy manufacturers, and the medical community," the researchers conclude.

Source: Pediatrics online 2003;111:e12-e16.

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Take a Bite Out of Crime: Get the Lead Out

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Monday, January 6, 2003

MONDAY, Jan. 6 (HealthScoutNews) -- Juvenile delinquency is often blamed on neglectful parents, lousy neighborhoods and poor schools.

New research reveals a startling possibility for the root of much of the bad behavior: exposure to lead.

Researchers tested the lead bone concentrations of 194 youths aged 12 to 18 convicted in the Allegheny County Juvenile Court in Pennsylvania and 146 students in regular high schools in Pittsburgh who did not have behavioral problems.

The study found delinquent children were four times as likely to have elevated concentrations of lead in their bones.

The mean concentration of lead in the convicted youths was 11.0 parts per million, compared to only 1.5 parts per million among other high schoolers.

Based on their findings, researchers attribute an estimated 11 percent to 38 percent of juvenile delinquency in Allegheny County to lead exposure.

"This study suggests a substantial proportion of delinquent behavior is due to a preventable cause -- lead," says Dr. Herbert Needleman, lead author of the study and a University of Pittsburgh professor of child psychiatry and pediatrics. "Very small amounts of lead are associated with toxicity."

The study appears in today's issue of Neurotoxicity and Teratology.

Needleman is one of the world's leading researchers on lead poisoning and children. He authored a groundbreaking 1979 study that found children with high levels of lead in their teeth, but no outward signs of lead poisoning, had lower IQ scores, shorter attention spans and poorer language skills.

Despite laws that banned the use of lead-based paint in 1978, lead exposure is still a major public health problem, says Dr. Dana Best, an assistant professor of pediatrics at George Washington University and medical director of the Children's National Medical Center.

The major source of lead exposure is deteriorating paint from older houses or from dust and soil contaminated with lead from older paint. Lead was used as a drying agent and to make colors brighter, Needleman explains.

More than 80 percent of U.S. homes built before 1978 have lead-based paint, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC). The older the house, the more likely it is to contain lead-based paint.

Lead poisoning, which can occur if children eat paint chips, can cause severe headaches and convulsions.

However, children don't have to eat paint chips to suffer lead exposure. Lead from old paint gets mixed into the dust in the house, and children ingest it when they put their fingers or toys in their mouths, Needleman says.

About 890,000 children aged 1 to 5 have elevated levels of lead in their blood, the CDC estimates. About 22 percent of black children living in housing built before 1946 have elevated blood lead levels.

For decades, parents have reported to pediatricians that their children's behavior changed after they were lead poisoned. Parents said their children became irritable, overactive and aggressive, he says.

Doctors still don't know exactly what lead, a neurotoxin, does to the brain to cause the cognitive and behavioral changes.

In 1996, Needleman published a study of 300 boys in public schools. It found that teachers and parents were more likely to report boys with high levels of lead in their bones engaged in antisocial activities such as bullying, vandalism, truancy and shoplifting.

The recommended safety level is no more than 10 micrograms per deciliter of blood, according to the CDC.

However, new research is showing that even children whose blood levels fall below that level have a small but statistically significant decrease in IQ, Best says.

"What we are learning is there is no safe level of lead," Best says.

In Allegheny County, public health officials say the study points to the need for renewed efforts to make sure children are safe from lead exposure.

Public health officials regularly set up clinics in grocery stores that offer free blood tests for lead exposure in children under 6. Years ago, testing turned up about 150 cases a year. In the last few years, that number has dropped to about 75 children a year, says Dave Zazec, an Allegheny County Health Department spokesman.

"If Dr. Needleman's study is corroborated, we are going to have to go back to the community and the medical community and put this issue back on the front burner," Zazec says. "Let's press the issue and make sure children at risk are screened for lead."

Lead poisoning is preventable. If you're concerned about your family's lead exposure, the CDC has this advice:

·         A simple blood test can determine if your child has been exposed.

  • If you live in a house or apartment built before 1978, contact your state or local health office about testing paint and dust in your home.
  • Use a damp mop to clean floors and other surfaces. Frequently wash children's hands, pacifiers and toys.
  • Use only cold water from the tap for drinking, cooking and making baby formula. Hot water is more likely to contain higher levels of lead.

What To Do

For more information, check out the U.S. Centers for Disease Control and Prevention or the American Academy of Pediatrics.

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Backpacks Source of Face, Ankle and Hand Injuries

By Suzanne Rostler

Reuters Health

Monday, January 6, 2003

NEW YORK (Reuters Health) - While heaps of schoolbooks may be good for the brain, they are thought to be hard on the backs of kids who carry them in backpacks. But according to a new report, back problems are the least common acute injury caused by backpacks.

The survey of 247 school-aged children with backpack injuries who showed up at 100 US emergency departments found that the head or face was the most common injury site (22%), followed by the hand (14%), wrist or elbow (13%), shoulder (12%) and foot or ankle (12%).

Back injuries accounted for just 11% of injuries, and the combination of wearing a backpack and sustaining an injury to the back accounted for just 6% of all injuries, according to the report in the January issue of Pediatrics.

"People assume that because you are wearing the backpack on your back, that's where the injury will be," Dr. Eric J. Wall, a study author from Cincinnati Children's Hospital in Ohio, told Reuters Health. "But our study showed the opposite."

Tripping over the backpack was the most common cause of injury, followed by wearing the backpack and getting hit by a backpack. In most of the instances where a child was hit, the backpack was used as a weapon.

Wall suggested that schools ban children from swinging their packs and using them to hit other kids. Providing hooks or a place in classrooms or at desks to hold backpacks might help, he said.

Other Injuries included lacerations, punctured fingers from pencils, jammed fingers from reaching for books, and fractures from the backpack falling on hands, the study found.

The study can help public health officials to develop backpack injury prevention strategies, which should include ways to avoid being hit by or tripping over a backpack, according to the study authors.

"Recommending that children put their backpacks in a safe place so they do not trip over them, and not to use them as a weapon to hit another person, could eliminate more than 40% of backpack injuries presenting to the emergency department," they write.

Source: Pediatrics 2003;111:163-166.

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SUNDAY, JANUARY 5, 2003

Healthy Mouth, Healthy Body

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Sunday, January 5, 2003

SUNDAY, Jan. 5 (HealthScoutNews) -- Your eyes may be the window to your soul, but your mouth can often tell your dentist what's going on with the rest of your body.

The links between oral health and overall health are many, dental and other experts now concur.

That's especially true if you're an aging baby boomer who may be susceptible to serious health problems such as heart disease and diabetes.

Over the years, dentists have changed the scope of their exams, partly to catch such diseases in their early stages, says Dr. Craig W. Valentine, a spokesman for the Academy of General Dentistry. A look in the mouth by a dentist, he says, can yield a lot of valuable health information.

However, many people aren't taking advantage of this knowledge, according to a recent survey of nearly 300 Americans, aged 45 to 64, that was commissioned by the academy. While 78 percent of those polled say dental care is a vital part of preventive health care, 49 percent admitted they don't visit the dentist every six months as recommended. And 31 percent are in the "kicking and screaming" category -- either they go to the dentist if they have an emergency, such as a terrible toothache, or they never go.

These lapsed patients may be surprised to find out that the modern dental exam has changed quite a bit.

"The exam has changed mainly because of two things," Valentine says. One is more awareness of cancers of the mouth, which dentists now screen for. Another is the growing consensus that a good dentist can help you keep not only your teeth but your overall health in good shape, he says.

"We are asking more questions of our patients," Valentine says.

Many dentists now ask about your saliva quality, what medications you're on, the date of your last physical, and other questions that may not seem to have anything to do with your teeth. From the patient's answers, and their own observations, dentists can piece together conclusions about the patient's overall health -- and perhaps suggest that a physical exam is also in order.

Valentine often hears from his boomer patients, for instance, that they have a burning or sour taste in their mouth. After investigating further, he often suspects they have gastroesophageal reflux disease, or GERD, in which stomach acid splashes back up, and refers them to a doctor. The condition can be treated with medication.

Bad breath or bleeding gums can be a symptom of adult onset diabetes, according to the academy. So can dry mouth or receding gums.

Dentists can also tell if you're stressed by examining the mouth, says Dr. Glenn Clark, a professor of oral biology and medicine at University of California, Los Angeles School of Dentistry.

One telltale sign of stress is bruxism, the grinding or clenching of your teeth, says Clark, another expert who tries to educate the public about the oral health-overall health link.

"Occasionally, the tissues of the mouth will change. Patients may have red spots on their tongue, which can point to immune-related disorders," he adds.

Oral inflammation that doesn't subside is another red flag, Clark says. "If you are immunosuppressed, have leukemia or AIDS (news - web sites), you will have things in the mouth that don't look right, such as ulcerative lesions or gum inflammation," he says.

What about the gum disease-heart disease debate?

"There's been a lot of controversy," Valentine says. Some research says the two are linked, while other studies refute the association. "My feeling is, if someone is not taking good care of their mouth they will have gum disease problems and they are probably not taking good care of the rest of their body, either," he says.

A dental X-ray can even alert a dentist to possible osteoporosis, Valentine says. "If I see bone loss on the X-ray of a tooth, it could be they have plaque around the tooth. But bone loss could be the result of osteoporosis. If so, I send them in for a bone density test."

And as saliva production decreases with age -- and it begins to, Clark says, around age 50 -- the incidence of cavities around the roots of teeth increase, setting up some boomers for a whole new round of cavities.

It's easy to put off the routine trip to the dentist every six months. But dentists urge their patients to think of it not just as a drill-and-fill appointment, but a health check-up.

What To Do

For more information on how oral health mirrors overall health, see the American Dental Association. The ADA also offers details on how your dental needs change with age.

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SATURDAY, JANUARY 4, 2003

Attack Those Allergies

HealthScoutNews

Saturday, January 4, 2003

SATURDAY, Jan. 4 (HealthScoutNews) -- Start the New Year off right and wise up about your allergies.

The American College of Allergy, Asthma and Immunology (ACAAI) recently launched a national education campaign called "Get Smart About Allergies."

The campaign encourages people with allergies to see an allergist or family doctor to get the best possible treatment so allergies don't interfere with their lives or lead to health consequences such as sinus and ear infections, asthma and sleep problems.

This public education effort comes after a ACAAI survey that found 94 percent of people with allergies believe their quality of life -- including work productivity, sleep, concentration and sex lives -- is harmed by their allergies.

The program includes a brochure that offers guidelines on how people can manage their allergies. It also explains why they should consult with a family doctor or allergy specialist.

The brochure explains the risks of not getting medical advice and also includes information about the potential dangers of over-the-counter (OTC) allergy medications.

A Web site and public service announcement are also part of the campaign.

A national telephone survey by the ACAAI found that while many people with allergies said it affected their quality of life, only 50 percent considered allergies to be a serious medical condition. Nearly two-thirds of them said they didn't see an allergist or other doctor the last time they had allergy symptoms.

The survey also found that 41 percent of people with allergies said they incorrectly assessed their condition as a common cold. The survey respondents tried an average of at least five OTC allergy medications. Nearly half said the reason they tried more than one OTC allergy medication was because they were dissatisfied with the effectiveness of the OTC medications.

The ACAAI says that shows the importance of going to a family doctor or allergist for the best treatment.

More information

Here's where you can find the Get Smart About Allergies Web site.

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